TABLE 3.1 Nine Components of the Eye Examination
the eyes should be equal. The test should be repeated on the opposite eye. To test for an afferent pupillary defect, the light is again shone in the first eye and then swung to the other eye (swinging flashlight test). If the pupils respond differently to the light stimuli, a retinal or optic nerve disease process is suspected.
Figure 3.6: Papilledema—note the obscured optic disk margins and hyperemia due to dilated capillaries.
Bilateral optic disc swelling is seen in intracranial hypertension, from idiopathic intracranial hypertension (see Figure 3.6), cerebral venous sinus thrombosis, or intracranial hemorrhage. Unilateral papilledema is extremely rare and suggests a disease in the eye itself such as a mass/tumor.
Figure 3.7: Central retinal artery occlusion—retinal edema (ischemic retinal whitening) and a cherry red spot due to underlying normal choroidal circulation.
perilimbal injection, conjunctival edema, and increased IOP (>50 mm Hg). Patients may also have a dilated, poorly reactive pupil (Table 3.2). Experienced providers may be able to see a shallow anterior chamber depth on slit lamp examination or ocular US.
Figure 3.9: Retinal detachment that appears as marked elevation or separation from the surrounding retinal (retinal fold or flap in top right quarter of the retina).
TABLE 3.2 Treatment of Acute Angle-Closure Glaucoma/Increased Intraocular Pressure