Tufts OpenCourseware
Author: Kanchan Ganda, M.D.
Color Key
Important key words or phrases.
Important concepts or main ideas.

1. Ophthalmic (The Eyes)

  • Ask the patient if he/she is having difficulty seeing near or far objects.
  • Is there any pain in the eyes or blurring of vision?
  • Does the patient experience any halos around lights?
    • Halos are when a white ring is seen around a source of light.
    • This is frequently seen with glaucoma (an elevation of intraocular pressure).
    • Glaucoma is an eye problem associated with an increase in intraocular pressure due to the blockage of the canal of Schlemm.
  • Does the patient see specks that float or move, suggesting vitreous floaters?
    • Fixed defects with change of gaze suggest retinal problems.
  • If the eyeballs are enlarged and the patient has been diagnosed with having hyperthyroidism, then the enlargement of the eyes is referred to as exophthalmus.
    • The eyelids do not roll over the eyeball when the patient gazes down while the head is in a fixed position .
    • Normally, the upper eyelid rolls over the eyeball.
    • This is referred to as a positive lid lag.
    • You can confirm this by holding the patient’s head steady with one hand and the patient’s gaze follows the finger of your other hand, which you move downward gradually.
    • With true exophthalmus you will notice this lag and you will also see the white of the patient’s sclera.
    • This is referred to as a positive lid lag test.
  • Enophthalmus is a sinking in of the eyeballs.
    • It is often seen with sudden weight loss, as in anorexia nervosa, patients suffering from cancers, AIDS, etc.
  • Patients should be treated in a semi-sitting position only.