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.