The Physical Examination of the Eye

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This article is a review of the anatomy of the eye and its surrounding tissues. A working knowledge of the functional anatomy of the eye will aid the emergency physician in performing a thorough yet efficient physical examination of the eye. A goal-directed physical examination of the eye will allow the emergency physician to attempt to identify (or exclude) visionthreatening disease processes and facilitate communication with the ophthalmologist.

Section snippets

The orbit

The orbit is composed of four walls. The roof of the orbit is comprised of the frontal bone and the lesser wing of the sphenoid bone. The lateral wall is made of the zygomatic bone and the greater wing of the sphenoid bone. The lateral wall and roof are separated by the superior orbital fissure. The floor of the orbit is composed primarily of the maxilla. However, portions of the zygomatic and palatine bones contribute to the floor. The medial wall is formed by portions of multiple bones

The external eye

The external anatomy of the eye is made up of the eyebrows, the eyelids, and the lacrimal apparatus. The eyebrows consist of thick skin and hair with muscle fibers underneath. The eyelids function to protect the eyeball by closing. They are made of thin skin covering the orbicularis oculi muscle. This muscle closes the lids. Beneath the muscle is areolar tissue followed by a fibrous connective tissue layer called the “tarsal plate.” The lids are covered on their posterior surface by mucosa

The eyeball

A review of daytime presentations to an ophthalmologic emergency department in Sydney, Australia found the following five most common diagnoses: conjunctivitis, keratitis, cataract, corneal abrasion, and iridocyclitis [9].

The extraocular muscles

The extraocular muscles control the movements of the eye. There are six extraocular muscles.

Innervation of the eye

The eye is innervated by the cranial nerves listed below.

The blood supply of the eye

The first branch of the intracranial section of the internal carotid artery is the ophthalmic artery. The ophthalmic artery and its subsequent branches supply the main blood source to the eye and its structures. After the ophthalmic artery enters the orbit, the first branch is the central retinal artery. As the artery continues to course within the orbit, multiple other branches supply the structures of the eye until the most superficial branches reach the eyelids. Here they form arcades that

Physical examination of the eye

In performing the physical examination of the eye, one should be able to evaluate both anatomy and function of each eye. The evaluation of the anatomy should focus on whether the problem arises from the globe, the orbit, or the external structures. The evaluation of the function of the eye should include vision, alignment, and movements. Generally, the physical examination of the eye should begin with a measurement of visual acuity (an exception to this is when ocular exposure to toxic

Summary

This article has provided a review of the anatomy of the eye and its surrounding tissues. A working knowledge of the functional anatomy of the eye will aid the emergency physician in performing a thorough yet efficient physical examination of the eye. A goal-directed physical examination of the eye will allow the emergency physician to attempt to identify (or exclude) vision-threatening disease processes and facilitate communication with the ophthalmologist.

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