The Physical Examination of the Eye
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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Acute painless vision loss in a young person
2013, Journal of Emergency MedicineSurgical Ophthalmologic Examination
2012, Oral and Maxillofacial Surgery Clinics of North AmericaCitation Excerpt :Prior ocular history has implications for physical examination and management, and current complaints and findings need to be put in the context of preexisting conditions. The history should include previous ocular trauma, use of corrective lenses, and ocular conditions including corneal scarring, amblyopia, glaucoma, macular degeneration, cataracts, Graves disease, diabetic retinopathy, and optic neuropathy.4,14,15 Previous ocular surgeries should be documented.
Evaluation of the painful eye
2016, American Family PhysicianCitation Excerpt :To test extraocular movements, the patient should be instructed to fixate on a target with both eyes and follow it in at least four different directions. Increased intraocular pressure from acute angle-closure glaucoma may cause disordered eye motility or pain with eye movement.29 Pain associated with eye movement may also occur with scleritis, optic neuritis, and orbital cellulitis.
The red eye
2011, CMAJ. Canadian Medical Association JournalCitation Excerpt :A corneal ulcer will also be detected with fluorescein, but a whitish corneal opacity will be visible before use of the dye. A portable tonometer accurately measures intraocular pressure and is useful in assessing suspected acute angle-closure glaucoma.3 If tonometry is unavailable, the presence of equal, round, reactive pupils essentially rules out acute angle-closure glaucoma.2
Differences Between Angle Configurations in Different Body Positions by Ultrasound Biomicroscopy in Patients with Cortical Age-Related Cataract
2023, Clinical Interventions in Aging