Causes of Eye cancer
Eye cancer Causes: Book Excerpts
Eye cancer as a complication of other conditions:
Other conditions that might have
Eye cancer as a complication may,
potentially, be an underlying cause of Eye cancer.
Our database lists the following as having
Eye cancer as a complication of that condition:
Related information on causes of Eye cancer:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Eye cancer may be found in:
Causes of Eye cancer: Online Medical Books
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for more information about the causes of Eye cancer.
Red Eye:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Conjunctivitis
–Allergic (allergens, irritants)
–Viral (adenovirus, HSV, varicella)
–Bacterial: Adults (Staphylococcus aureus,
S. epidermidis, E. coli, Pseudomonas spp, Streptococcus spp), children (Haemophilus influenzae can cause otitis/conjunctivitis syndrome), Streptococcus pneumoniae, Moraxella catarrhalis, Staphylococcus spp), newborns (gonorrhea, Chlamydia)
Corneal abrasion/ulceration
Subconjunctival hemorrhage
Episcleritis
Scleritis (inflammation of conjunctiva and deep layers of globe)
Keratoconjunctivitis sicca
–Rheumatoid arthritis
–Sjögren's syndrome
Acute angle closure glaucoma
Acute iritis
Anterior uveitis
Pinguecula
Pterygium
Viral keratitis (disruption of the corneal epithelium): Herpes simplex/Zoster
Contact lens complications (e.g., infections with Acanthamoeba, Pseudomonas)
Trauma
Chemical burns (e.g., cyanoacrylate injury)
Orbital cellulitis (especially in children)
Acute ethmoiditis
Eyelid abnormalities
Trichiasis
Entropion
Molluscum contagiosum
Kawasaki's disease
Measles
UV radiation-induced photokeratitis
Pseudotumor cerebri
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Scleral Injection (Red Eye):
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Bacterial conjunctivitis: Common; usually BL; acute-onset purulent/mucopurulent discharge; conjunctival hyperemia; caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae
-
Allergic conjunctivitis: Common; BL; seasonal/perennial; lid edema, watery, stringy discharge, conjunctival hyperemia
-
Viral conjunctivitis: Common; very contagious; usually BL; lid edema, watery discharge, conjunctival hyperemia, preauricular adenopathy, cornea infiltrates and ulcers possible; caused by adenovirus, HSV, enterovirus
-
Neonatal conjunctivitis: Conjunctival inflammation in first month; etiologies chemical, Gonococcus, HSV-2, Chlamydia, bacterial
-
Corneal ulcer: Bacterial, viral, autoimmune, parasitic, fungal
-
Corneal abrasion: Contact lens use; trauma; recurrent corneal erosions
-
Giant papillary conjunctivitis: Common; secondary to foreign body (contact lens)
-
Vernal keratoconjunctivitis: Common, recurrent; BL; mucoid discharge; limbal infiltrates and vascularization
-
Atopic keratoconjunctivis: Uncommon; lid eczema; mucoid discharge; corneal vascularization
-
Blepharitis/meibomitis: Infection, inflammation of eyelid margin lead to conjunctival and corneal irritation
-
Mucocutaneous: Stevens-Johnson syndrome; atopic dermatitis; toxic epidermolysis bullosa; keratoconjunctivitis sicca, rosacea
-
Scleritis/episcleritis: Red, tender, no significant discharge; with connective tissue disease and vasculitis
-
Canaliculitis/dacrocystitis: Infection of nasolacrimal system
-
Subconjunctival hemorrhage: Bright red; resolves over 7–14 days; spontaneous or associated with valsalva
-
Iritis: Autoimmune disease associations; perilimbal injection; photophobia, ache
-
Angle closure glaucoma: Halos, headache, nausea and vomiting, history of hyperopia
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Eye Discharge:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Blocked tear duct (nasolacrimal duct stenosis)
–Occurs in 5–10% of normal newborns
–Tearing and mucus discharge secreted to lubricate the eye accumulate at the medial canthus because it cannot drain through the fused nasolacrimal duct
–Frequently the discharge is mistaken for pus; also superinfection and conjunctivitis may occur
- Allergic conjunctivitis
–Mucoid discharge, injection, and pruritus are the typical symptoms
–Symptoms may be seasonal or perennial, depending on the allergy (ragweed vs dust)
–Patients frequently have a history of other atopic disease (e.g., allergic rhinitis, asthma, or eczema)
- Viral conjunctivitis
–Adenovirus: Frequently associated with fever and pharyngitis, very contagious, and may have preauricular nodes
–Human herpesvirus: HSV1 may cause conjunctivitis, frequently accompanied by herpetic lesions on the face
- Bacterial conjunctivitis
–Staphylococcus aureus
–Haemophilus influenzae (non-typable): May cause simultaneous otitis, should be treated for penicillin-resistant organisms
–Chlamydia trachomatis and Neisseria gonorrhoeae (newborn): Suspect in an infant of a mother with a history of inadequate prenatal care or any sexually transmitted disease; physical signs are usually impressive; C. trachomatis may also cause pneumonia; must be treated systemically
-
Foreign body
–Patient usually relates a history consistent with FB
-
Corneal abrasion
–May manifest as an FB sensation
-
Glaucoma
–May be congenital, acquired, or syndrome-associated; in young children it presents with tearing, progressive enlargement of the eye, and corneal changes
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Raccoon eyes:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Basilar skull fracture
A basilar skull fracture produces raccoon eyes after head trauma that doesn’t involve the orbital area. Associated signs and symptoms vary with the fracture site and may include pharyngeal hemorrhage, epistaxis, rhinorrhea, otorrhea, and a bulging tympanic membrane from blood or CSF. The patient may experience difficulty hearing, a headache, nausea, vomiting, cranial nerve palsies, and an altered LOC. He may also exhibit a positive Battle’s sign.
Other causes
Surgery
Raccoon eyes occurring after craniotomy may indicate a meningeal tear and bleeding into the sinuses.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Doll's eye sign, absent:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Brain stem infarction
Brain stem infarction causes absent doll's eye sign with coma. It also causes limb paralysis, cranial nerve palsies (facial weakness, diplopia, blindness or visual field deficits, and nystagmus), bilateral cerebellar ataxia, variable sensory loss, a positive Babinski's reflex, decerebrate posture, and muscle flaccidity.
Brain stem tumor
Absent doll's eye sign accompanies coma in a brain stem tumor. This sign may be preceded by hemiparesis, nystagmus, extraocular nerve palsies, facial pain or sensory loss, facial paralysis, a diminished corneal reflex, tinnitus, hearing loss, dysphagia, drooling, vertigo, dizziness, ataxia, and vomiting.
Central midbrain infarction
Accompanying absent doll's eye sign are coma, Weber's syndrome (oculomotor palsy with contralateral hemiplegia), contralateral ataxic tremor, nystagmus, and pupillary abnormalities.
Pontine hemorrhage
Absent doll's eye sign and coma develop within minutes with pontine hemorrhage, a life-threatening disorder. Other ominous signs — such as complete paralysis, decerebrate posture, a positive Babinski's reflex, and small, reactive pupils — may rapidly progress to death.
Posterior fossa hematoma
A subdural hematoma at the posterior fossatypically causes absent doll's eye sign and coma. These signs may be preceded by characteristic signs and symptoms, such as a headache, vomiting, drowsiness, confusion, unequal pupils, dysphagia, cranial nerve palsies, a stiff neck, and cerebellar ataxia.
Other causes
Drugs
Barbiturates may produce severe central nervous system depression, resulting in coma and absent doll's eye sign.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Setting sun sign [Sunset eyes]:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Increased ICP
Transient or intermittent setting-sun sign usually occurs late in the infant with increased ICP. He may have bulging, widened fontanels, an increased head circumference, and widened sutures. He may also exhibit a decreased LOC, behavioral changes, a high-pitched cry, pupillary abnormalities, and impaired motor movement as ICP increases. Other findings include increased systolic pressure, widened pulse pressure, bradycardia, changes in breathing pattern, vomiting, and seizures as ICP increases.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Eye pain [Ophthalmalgia]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute angle-closure glaucoma
Blurred vision and sudden excruciating pain in and around the eye characterize this disorder; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.
Astigmatism
Uncorrected astigmatism commonly causes headaches and eye fatigue, aching, and redness. This disorder occurs in both older and younger people.
Blepharitis
Burning pain in both eyelids is accompanied by conjunctival injection and an itching, sticky discharge. Related findings include a foreign-body sensation, eyelid ulcerations, and loss of eyelashes.
Burns
In chemical burns, sudden severe eye pain may occur with erythema and blistering of the face and eyelids, photophobia, miosis, conjunctival injection, blurring, and inability to keep the eyelids open. In ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.
Chalazion
A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.
Conjunctivitis
Some degree of eye pain and excessive tearing occur in four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge.
Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it typically produces burning, a foreign-body sensation, a purulent discharge, and conjunctival injection.
If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.
Viral conjunctivitis produces itching, red eyes; a foreign-body sensation; visible conjunctival follicles; and eyelid edema.
Corneal abrasions
This type of injury typically produces a foreign-body sensation, excessive tearing, photophobia, and conjunctival injection.
Corneal erosion (recurrent)
In this disorder, severe pain occurs on waking and continues throughout the day. Accompanying the pain are conjunctival injection and photophobia.
Corneal ulcers
Both bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea; unilateral pupil constriction; and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.
Dacryoadenitis
Temporal pain may affect both eyes in this disorder. Associated findings include exophthalmos, conjunctival injection, severe eyelid erythema and edema, and a purulent eye discharge.
Dacryocystitis
Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling around the lacrimal punctum.
Episcleritis
Deep eye pain occurs as tissues over the sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.
Erythema multiforme major
This disorder commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.
Foreign bodies in the cornea and conjunctiva
Sudden severe pain is common in this condition, but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.
Glaucoma
Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Acute angle-closure glaucoma may cause severe pain and pressure over the eye, blurred vision, halo vision, decreased visual acuity, and nausea and vomiting.
Herpes zoster ophthalmicus
Eye pain occurs with severe unilateral facial pain, usually several days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.
Hordeolum (stye)
This lesion usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.
Hyphema
Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and eyelid edema, conjunctival injection, and visual impairment may also occur.
Interstitial keratitis
Associated with congenital syphilis, this corneal inflammation produces eye pain with photophobia, blurred vision, prominent conjunctival injection, and grayish pink corneas.
Iritis (acute)
Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.
Keratoconjunctivitis sicca
This condition—known as dry eye syndrome—causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. A copious mucoid discharge and inadequate tearing are typical.
Lacrimal gland tumor
This neoplastic lesion usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.
Migraine headache
Migraines can produce head pain so severe that the eyes also ache. Nausea, vomiting, blurred vision, and light and noise sensitivity may also occur.
Ocular laceration and intraocular foreign bodies
Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.
Optic cellulitis
This disorder causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, a purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.
Optic neuritis
In this disorder, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.
Orbital floor fracture
Sometimes called a blowout fracture, this injury causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia.
Orbital pseudotumor
This disorder causes deep, boring eye pain and diplopia in about 50% of patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and limited extraocular movement may also occur.
Pemphigus
In this disorder, bilateral eye pain and irritation may be accompanied by blurred vision and a thick discharge. Blisters may develop on the conjunctiva alone or may extend to the nasal, oral, and vulvar mucous membranes as well as the skin.
Scleritis
This inflammation produces severe eye pain and tenderness, conjunctival injection, bluish purple sclera and, possibly, photophobia and excessive tearing.
Sclerokeratitis
Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.
Subdural hematoma
Following head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma’s location and size.
Trachoma
Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, an eye discharge, eyelid edema and erythema, and visible conjunctival follicles.
Uveitis
Anterior uveitis causes sudden severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.
Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape.
Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.
Other causes
Treatments
Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Doll's eye sign, absent [Negative oculocephalic reflex]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Brain stem infarction
This infarction causes absent doll’s eye sign with a coma. It also causes limb paralysis, cranial nerve palsies (facial weakness, diplopia, blindness or visual field deficits, and nystagmus), bilateral cerebellar ataxia, variable sensory loss, a positive Babinski’s reflex, decerebrate posture, and muscle flaccidity.
Brain stem tumor
Absent doll’s eye sign accompanies a coma in this type of tumor. This sign may be preceded by hemiparesis, nystagmus, extraocular nerve palsies, facial pain or sensory loss, facial paralysis, diminished corneal reflex, tinnitus, hearing loss, dysphagia, drooling, vertigo, dizziness, ataxia, and vomiting.
Central midbrain infarction
Accompanying absent doll’s eye sign are a coma, Weber’s syndrome (oculomotor palsy with contralateral hemiplegia), contralateral ataxic tremor, nystagmus, and pupillary abnormalities.
Cerebellar lesion
Whether associated with abscess, hemorrhage, or tumor, a cerebellar lesion that progresses to a coma may also cause an absent doll’s eye sign. The coma may be preceded by headache, nystagmus, ocular deviation to the side of the lesion, unequal pupils, dysarthria, dysphagia, ipsilateral facial paresis, and cerebellar ataxia. Characteristic signs of increased ICP may also occur, including decreased LOC, abnormal pupillary responses, increased systolic blood pressure, widening pulse pressure, bradycardia, altered respiratory pattern, papilledema, and vomiting.
Pontine hemorrhage
Absent doll’s eye sign and a coma develop within minutes in this life-threatening disorder. Other ominous signs—such as complete paralysis, decerebrate posture, a positive Babinski’s reflex, and small, reactive pupils—may rapidly progress to death.
Posterior fossa hematoma
A subdural hematoma at this location typically causes absent doll’s eye sign and a coma. These signs may be preceded by characteristic signs and symptoms, such as headache, vomiting, drowsiness, confusion, unequal pupils, dysphagia, cranial nerve palsies, stiff neck, and cerebellar ataxia.
Other causes
Drugs
Barbiturates may produce severe central nervous system depression, resulting in a coma and absent doll’s eye sign.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Raccoon eyes:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Basilar skull fracture
This injury produces raccoon eyes after head trauma that doesn’t involve the orbital area. Associated signs and symptoms vary with the fracture site and may include pharyngeal hemorrhage, epistaxis, rhinorrhea, otorrhea, and a bulging tympanic membrane from blood or CSF. The patient may experience difficulty hearing, headache, nausea, vomiting, cranial nerve palsies, and altered LOC. He may also exhibit a positive Battle’s sign.
Other causes
Surgery
Raccoon eyes occurring after craniotomy may indicate a meningeal tear and bleeding into the sinuses.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Eye discharge:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Canaliculitis
This uncommon chronic disorder causes a scant purulent discharge, usually from the lower canaliculus of one eye. The eye is red and irritated, and its punctum bulges a bit.
Conjunctivitis
Five types of conjunctivitis may cause an eye discharge with redness, hyperemia, foreign-body sensation, periocular edema, and tearing.
In allergic conjunctivitis, a bilateral ropey discharge is accompanied by itching and tearing.
Bacterial conjunctivitis causes a moderate purulent or mucopurulent discharge that may form sticky crusts on the eyelids during sleep. The discharge is commonly greenish white and usually occurs in one eye. The patient may also experience itching, burning, excessive tearing, and the sensation of a foreign body in the eye. Eye pain indicates corneal involvement. Preauricular adenopathy is uncommon.
Viral conjunctivitis, which is more common than the bacterial form, usually produces a serous, clear discharge and preauricular adenopathy. The history includes a runny nose, an upper respiratory tract infection, or recent contact with a person who had these signs. Onset is usually unilateral.
Fungal conjunctivitisproduces a copious, thick, purulent discharge that makes the eyelids crusty and sticky. Also characteristic are eyelid edema, itching, burning, and tearing. Pain and photophobia occur only with corneal involvement.
Inclusion conjunctivitis causes a scant mucoid discharge—especially in the morning—in both eyes, accompanied by pseudoptosis and conjunctival follicles.
Corneal ulcers
Both bacterial and fungal ulcers produce a copious, purulent unilateral eye discharge and crusty, sticky eyelids. Severe pain, photophobia, and impaired visual acuity may also occur.
Bacterial corneal ulcers are also characterized by an irregular gray-white area on the cornea, blurred vision, unilateral pupil constriction, and conjunctival injection.
Fungal corneal ulcers are also characterized by conjunctival injection and eyelid edema and erythema. A painless, dense, whitish gray central ulcer develops slowly and may be surrounded by progressively clearer rings.
Dacryoadenitis
This disorder may cause a moderate purulent discharge associated with temporal eye pain, conjunctival injection, and severe eyelid edema and erythema. However, its most characteristic sign is unilateral exophthalmos.
Dacryocystitis
A lacrimal sac infection may produce a scant but continuous purulent discharge that’s easily expressed from the tear sac. Additional signs and symptoms include excessive tearing, pain, and tenderness near the tear sac. Eyelid inflammation and edema are most noticeable around the lacrimal punctum.
Erythema multiforme major (Stevens-Johnson syndrome)
Ocular effects of this disorder include a purulent discharge, severe eye pain, entropion, trichiasis, photophobia, and decreased tear formation. Also typical are erythematous, urticarial, bullous lesions that suddenly erupt over the skin.
Herpes zoster ophthalmicus
This disorder yields a moderate to copious serous eye discharge accompanied by excessive tearing. Examination reveals eyelid edema and erythema, conjunctival injection, and a white, cloudy cornea. The patient also complains of eye pain and severe unilateral facial pain that occurs several days before vesicles erupt.
Keratoconjunctivitis sicca
Better known as dry eye syndrome, this disorder typically causes a copious and continuous mucoid discharge and insufficient tearing. Accompanying signs and symptoms include eye pain, itching, burning, a foreign-body sensation, and dramatic conjunctival injection. The patient may also have difficulty closing his eyes.
Meibomianitis
In this disorder, applying pressure on the meibomian glands may produce a continuous frothy, soft, foul-smelling, cheesy yellow eye discharge. The eyes also appear chronically red, with inflamed lid margins.
Orbital cellulitis
Although exophthalmos is the most obvious sign of this disorder, a unilateral purulent eye discharge may also be present. Related findings include eyelid edema, conjunctival injection, orbital pain, impaired visual acuity, limited extraocular movement, headache, and fever.
Pemphigus
This rare disorder may cause a thick, mucuslike discharge; eye pain, burning, and irritation; and blurred vision. Initially, the patient may develop unilateral or bilateral conjunctivitis that’s unrelieved by treatment; later, entropion and, occasionally, corneal ulceration may occur.
Psoriasis vulgaris
Usually, psoriasis vulgaris causes a substantial mucoid discharge in both eyes, accompanied by redness. The characteristic lesions it produces on the eyelids may extend into the conjunctivae, causing irritation, excessive tearing, and a foreign-body sensation.
Trachoma
A bilateral eye discharge occurs in this disorder along with severe pain, excessive tearing, photophobia, eyelid edema, redness, and visible conjunctival follicles.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Setting-sun sign [Sunset eyes]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Increased ICP
Transient or intermittent setting-sun sign often occurs late in patients with increased ICP. The infant may have bulging, widened fontanels, increased head circumference, and widened sutures. He may also exhibit a decreased level of consciousness, behavioral changes, a high-pitched cry, pupillary abnormalities, and impaired motor movement as ICP increases. Other findings include increased systolic pressure, widened pulse pressure, bradycardia, changes in breathing pattern, vomiting, and seizures as ICP increases.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Eye Pain:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Conjunctivitis
❑ Corneal abrasion
❑ Foreign body
❑ Sinusitis
❑ Migraine
❑ Acute glaucoma
❑ Orbital cellulitis
❑ Zoster prodrome
❑ Orbital fracture
❑ Keratitis
❑ Scleritis
❑ Iritis
❑ Optic neuritis
❑ Temporal arteritis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Red Eye:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Viral conjunctivitis
❑ Allergic conjunctivitis
❑ Bacterial conjunctivitis
❑ Corneal abrasion
❑ Foreign body
❑ Subconjunctival hemorrhage
❑ Hordeolum
❑ Blepharitis
❑ Photophthalmia
❑ Acute angle closure glaucoma
❑ Chlamydial conjunctivitis
❑ Hypopyon
❑ Dacryocystitis
❑ Herpes simplex keratitis
❑ Iritis
❑ Scleritis
❑ Gonococcal conjunctivitis
❑ Keratoconjunctivitis sicca
❑ Measles
❑ Endophthalmitis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Eye pain:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
See Eye pain: causes and associated findings, page 142.
Acute angle-closure glaucoma
Blurred vision and sudden, excruciating pain in and around the eye characterize acute angle-closure glaucoma; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.
Astigmatism
Uncorrected astigmatism commonly causes headache and eye fatigue, aching, and redness. This disorder occurs in both older and younger people.
Blepharitis
Burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include foreign-body sensation, lid ulcerations, and loss of eyelashes.
Burns
With chemical burns,
sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and inability to keep the eyelids open. (See
Eye irrigation for chemical burns, page 143.) With ultraviolet radiation burns,
moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.
Chalazion
A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.
Conjunctivitis
Some degree of eye pain and excessive tearing occurs with four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge.
Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.
If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.
Viral conjunctivitis produces itching, red eyes, foreign-body sensation, visible conjunctival follicles, and eyelid edema.
Corneal abrasions
With corneal abrasions, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common.
Corneal erosion (recurrent)
Severe pain occurs on waking and continues throughout the day. Accompanying the pain are conjunctival injection and photophobia.
Corneal ulcers
Both bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea, unilateral pupil constriction, and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.
Dacryoadenitis
Temporal pain may affect both eyes in dacryoadenitis. Associated findings include exophthalmos, conjunctival injection, severe eyelid erythema and edema, and a purulent eye discharge.
Dacryocystitis
Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include profuse tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.
Episcleritis
Deep eye pain occurs as tissues over sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.
Erythema multiforme major
Erythema multiforme major commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.
Foreign bodies in the cornea and conjunctiva
Sudden severe pain is common but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.
Glaucoma
Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Angle-closure glaucoma may cause pain and pressure over the eye, blurred vision, halo vision, decreased visual acuity, and nausea and vomiting.
Herpes zoster ophthalmicus
Eye pain occurs with severe unilateral facial pain, usually several days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.
Hordeolum (stye)
Hordeolum is a lesion that usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.
Hyphema
Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and lid edema, conjunctival injection, and visual impairment may occur.
Interstitial keratitis
Associated with congenital syphilis, interstitial keratitis produces eye pain with photophobia, blurred vision, prominent conjunctival injection, and grayish pink corneas.
Iritis (acute)
Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.
Keratoconjunctivitis sicca
Keratoconjunctivitis sicca — known as
dry eye syndrome — causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. Excessive mucoid discharge and inadequate tearing are typical.
Lacrimal gland tumor
Lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.
Migraine headache
Migraines can produce pain so severe that the eyes also ache. Additionally, nausea, vomiting, blurred vision, and light and noise sensitivity may occur.
Ocular laceration and intraocular foreign bodies
Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.
Optic cellulitis
Optic cellulitis causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.
Optic neuritis
With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.
Orbital floor fracture
Sometimes called a
blowout fracture, orbital floor fracture causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia.
Orbital pseudotumor
Orbital pseudotumor causes deep, boring eye pain and diplopia in about 50% of all patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and restricted extraocular movement may also occur.
Pemphigus
With pemphigus, bilateral eye pain and irritation may be accompanied by blurred vision and a thick discharge. Blisters may develop on the conjunctiva alone or may extend to the nasal, oral, and vulvar mucous membranes as well as the skin.
Scleritis
Scleritis is a inflammation that produces severe eye pain and tenderness, along with conjunctival injection, bluish purple sclera and, possibly, photophobia, loss of vision, and excessive tearing.
Sclerokeratitis
Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.
Subdural hematoma
After head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma’s location and size.
Trachoma
Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, eye discharge, eyelid edema and redness, and visible conjunctival follicles.
Uveitis
Anterior uveitis causes sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.
Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape.
Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.
Other causes
Medical treatments
Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Eye pain:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Blepharitis
With blepharitis, burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include foreign-body sensation, lid ulcerations, and loss of eyelashes.
Burns
With chemical burns, sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and inability to keep the eyelids open. With ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.
Chalazion
A chalazion causes localized pain, tenderness, redness, and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.
Conjunctivitis
Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge.
Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.
If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.
Viral conjunctivitis produces itching, red eyes, foreign-body sensation, visible conjunctival follicles, and eyelid edema.
Corneal abrasions
With corneal abrasions, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common. The patient commonly reports feeling that “something is in” the eye.
Corneal erosion (recurrent)
With recurrent corneal erosion, severe pain occurs on waking and continues throughout the day. Conjunctival injection and photophobia also occur.
Corneal ulcers
Both bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea, unilateral pupil constriction, and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.
Dacryocystitis
Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.
Foreign body in the cornea or conjunctiva
Sudden severe pain is common but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.
Glaucoma
Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Angle-closure glaucoma is characterized by blurred vision and sudden, excruciating pain in and around the eye. The pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.
Herpes zoster ophthalmicus
With herpes zoster ophthalmicus, eye pain occurs with severe unilateral facial pain, usually days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.
Hordeolum
A hordeolum (stye) usually produces localized eye pain, burning, and discomfort that increases as the stye grows. Eyelid erythema and edema are also common.
Hyphema
Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and lid edema, conjunctival injection, and visual impairment may occur. The patient may report nausea.
Keratoconjunctivitis sicca
Keratoconjunctivitis sicca, also known as dry eye syndrome, causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. Excessive mucoid discharge and inadequate tearing are typical.
Lacrimal gland tumor
Lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos. The patient may also have ptosis and eye deviation.
Ocular laceration and intraocular foreign bodies
Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.
Optic cellulitis
Optic cellulitis causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.
Optic neuritis
With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.
Orbital floor fracture
Sometimes called a blowout fracture, orbital floor fracture causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia. The patient may report recent eye trauma and reduced vision. Ecchymosis and ptosis may be visible.
Orbital pseudotumor
An orbital pseudotumor causes deep, boring eye pain and diplopia in about 50% of patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and restricted extraocular movement may also occur.
Uveitis
Anterior uveitis causes sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil. Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape. Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity (the patient usually can perceive only light).
Other causes
Treatments
Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Eye discharge:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Conjunctivitis
Five types of conjunctivitis may cause an eye discharge with redness, hyperemia, foreign-body sensation, periocular edema, and tearing.
With allergic conjunctivitis, a bilateral ropey discharge is accompanied by itching and tearing.
Bacterial conjunctivitis causes a moderate purulent or mucopurulent discharge that may form sticky crusts on the eyelids during sleep. The discharge is commonly greenish white and usually occurs in one eye. The patient may also experience itching, burning, excessive tearing, and the sensation of a foreign body in the eye. Eye pain indicates corneal involvement.
Viral conjunctivitis is generally more common than the bacterial form. A serous, clear discharge and preauricular adenopathy are usually present. The history includes a runny nose, an upper respiratory tract infection, or recent contact with a person who had these signs. Onset is usually unilateral.
Fungal conjunctivitisproduces a copious, thick, purulent discharge that makes the eyelids crusty and sticky. Also characteristic are eyelid edema, itching, burning, and tearing. Pain and photophobia occur only with corneal involvement.
Inclusion conjunctivitis causes scant mucoid discharge — especially in the morning — in both eyes, accompanied by pseudoptosis and conjunctival follicles.
Corneal ulcers
Both bacterial and fungal corneal ulcers produce a copious, purulent unilateral eye discharge. Related findings are crusty, sticky eyelids and, possibly, severe pain, photophobia, and impaired visual acuity.
Bacterial corneal ulcers are also characterized by an irregular gray-white area on the cornea, blurred vision, unilateral pupil constriction, and conjunctival injection.
Fungal corneal ulcers are also characterized by conjunctival injection and eyelid edema and erythema. A painless, dense, whitish gray central ulcer develops slowly and may be surrounded by progressively clearer rings.
Dacryocystitis
With dacryocystitis, lacrimal sac infection may produce scant but continuous purulent discharge that’s easily expressed from the tear sac. Additional signs and symptoms include excessive tearing, pain, and tenderness near the tear sac. Eyelid inflammation and edema are most noticeable around the lacrimal punctum.
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus yields a moderate to copious serous eye discharge accompanied by excessive tearing. Examination reveals eyelid edema and erythema, conjunctival injection, and a white, cloudy cornea. The patient also complains of eye pain and severe unilateral facial pain that occurs several days before vesicles erupt.
Keratoconjunctivitis sicca
Better known as dry eye syndrome, keratoconjunctivitis sicca typically causes excessive, continuous mucoid discharge and insufficient tearing. Accompanying signs and symptoms include eye pain, itching, burning, a foreign-body sensation, and dramatic conjunctival injection. The patient may also have difficulty closing his eyes.
Meibomianitis
Meibomianitis may produce a continuous frothy eye discharge. Applying pressure on the meibomian glands yields a soft, foul-smelling, cheesy yellow discharge. The eyes also appear chronically red, with inflamed lid margins.
Orbital cellulitis
Although exophthalmos is the most obvious sign of orbital cellulitis, a unilateral purulent eye discharge may also be present. Related findings include eyelid edema, conjunctival injection, headache, orbital pain, impaired visual acuity, limited extraocular movement, and fever.
Psoriasis vulgaris
Usually, psoriasis vulgaris causes a substantial mucus discharge in both eyes, accompanied by redness. The characteristic lesions it produces on the eyelids may extend into the conjunctiva, causing irritation, excessive tearing, and a foreign-body sensation.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Red Eye:
Principal Causes of Red Eye
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Conjunctivitis
- Chemicalsand irritants
- Infectious conjunctivitis
- Neonatal
- Postneonatal
- Allergic conjunctivitis
- Trauma
- Corneal abrasion
- Foreign body
- Hemorrhage
- Burn
- Blunt or penetrating injury
- Contact lens problems
- Child abuse
- Lid disorders
- Hordeolum
- Blepharitis
- Nasolacrimal duct obstruction includingdacryocystitis
- Allergic reactions
- Preseptal and orbital cellulitis
- Keratitis
- Superficial keratitis
- Nonsuperficial keratitis
- Uveitis
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Eye pain [Ophthalmalgia]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute angle-closure glaucoma.Blurred vision and sudden, excruciating pain in and around the eye characterize acute angle-closure glaucoma; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.
Blepharitis.Burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include a foreign-body sensation, lid ulcerations, and loss of eyelashes.
Burns.With chemical burns, sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and an inability to keep the eyelids open. With ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.
Chalazion.A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.
Conjunctivitis.Some degree of eye pain and excessive tearing occurs with four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge. Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.
If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.
Viral conjunctivitis produces itching, red eyes, a foreign-body sensation, visible conjunctival follicles, and eyelid edema.
Corneal abrasions.With this type of injury, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common.
Corneal ulcers.Bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea; unilateral pupil constriction; and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.
Dacryocystitis.Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.
Episcleritis.Deep eye pain occurs as tissues over the sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.
Erythema multiforme major.Erythema multiforme major commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.
Foreign bodies in the cornea and conjunctiva.Sudden severe pain is common, but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.
Hordeolum (stye).Hordeolum usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.
Iritis (acute).Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.
Lacrimal gland tumor.A lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.
Migraine headache.Migraines can produce pain so severe that the eyes also ache. Additionally, nausea, vomiting, blurred vision, and light and noise sensitivity may occur.
Ocular laceration and intraocular foreign bodies.Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.
Optic neuritis.With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.
Scleritis.Scleritis produces severe eye pain and tenderness, along with conjunctival injection, a bluish purple sclera and, possibly, photophobia and excessive tearing.
Sclerokeratitis.Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.
Subdural hematoma.Following head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma's location and size.
Trachoma.Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, eye discharge, eyelid edema and redness, and visible conjunctival follicles.
Uveitis.Anterior uveitis causes the sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.
Posterior uveitis causes an insidious onset of similar features as well as gradual blurring of vision and distorted pupil shape.
Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.
Other causes
Treatments and surgery.Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Doll's eye sign, absent [Negative oculocephalic reflex]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Brain stem infarction.Brain stem infarction causes absent doll's eye sign with coma. It also causes limb paralysis, cranial nerve palsies (facial weakness, diplopia, blindness or visual field deficits, and nystagmus), bilateral cerebellar ataxia, variable sensory loss, a positive Babinski's reflex, decerebrate posture, and muscle flaccidity.
Brain stem tumor.Absent doll's eye sign accompanies coma with a brain stem tumor. This sign may be preceded by hemiparesis, nystagmus, extraocular nerve palsies, facial pain or sensory loss, facial paralysis, a diminished corneal reflex, tinnitus, hearing loss, dysphagia, drooling, vertigo, dizziness, ataxia, and vomiting.
Central midbrain infarction.With a central midbrain infarction, absent doll's eye sign is associated with coma, Weber's syndrome (oculomotor palsy with contralateral hemiplegia), contralateral ataxic tremor, nystagmus, and pupillary abnormalities.
Pontine hemorrhage.Absent doll's eye sign and coma develop within minutes with pontine hemorrhage, a life-threatening disorder. Other ominous signs—such as complete paralysis, decerebrate posture, a positive Babinski's reflex, and small, reactive pupils—may rapidly progress to death.
Posterior fossa hematoma.A subdural hematoma at the posterior fossa typically causes absent doll's eye sign and coma. These signs may be preceded by characteristic signs and symptoms, such as a headache, vomiting, drowsiness, confusion, unequal pupils, dysphagia, cranial nerve palsies, a stiff neck, and cerebellar ataxia.
Other causes
Drugs.Barbiturates may produce severe central nervous system depression, resulting in coma and absent doll's eye sign.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Raccoon eyes:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Basilar skull fracture.A basilar skull fracture produces raccoon eyes after head trauma that doesn't involve the orbital area. Associated signs and symptoms vary with the fracture site and may include pharyngeal hemorrhage, epistaxis, rhinorrhea, otorrhea, and a bulging tympanic membrane from blood or CSF. The patient may experience difficulty hearing, headache, nausea, vomiting, cranial nerve palsies, and altered LOC. He may also exhibit a positive Battle's sign.
Other causes
Surgery.Raccoon eyes occurring after a craniotomy may indicate a meningeal tear and bleeding into the sinuses.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Eye discharge:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Conjunctivitis.Five types of conjunctivitis may cause an eye discharge with redness, hyperemia, foreign-body sensation, periocular edema, and tearing.
With allergic conjunctivitis, a bilateral ropey discharge is accompanied by itching and tearing.
Bacterial conjunctivitis causes a moderate purulent or mucopurulent discharge that may form sticky crusts on the eyelids during sleep. The discharge is commonly greenish white and usually occurs in one eye. The patient may also experience itching, burning, excessive tearing, and the sensation of a foreign body in the eye. Eye pain indicates corneal involvement. Preauricular adenopathy is uncommon.
Viral conjunctivitis is generally more common than the bacterial form. A serous, clear discharge and preauricular adenopathy are usually present. The history includes a runny nose, an upper respiratory tract infection, or recent contact with a person who had these signs. The onset is usually unilateral.
Fungal conjunctivitis produces a copious, thick, purulent discharge that makes the eyelids crusty and sticky. Also characteristic are eyelid edema, itching, burning, and tearing. Pain and photophobia occur only with corneal involvement.
Inclusion conjunctivitis causes scant mucoid discharge—especially in the morning—in both eyes, accompanied by pseudoptosis and conjunctival follicles.
Corneal ulcers.Bacterial and fungal corneal ulcers produce a copious, purulent unilateral eye discharge. Related findings are crusty, sticky eyelids and, possibly, severe pain, photophobia, and impaired visual acuity.
Bacterial corneal ulcers are also characterized by an irregular gray-white area on the cornea, blurred vision, unilateral pupil constriction, and conjunctival injection.
Fungal corneal ulcers are also characterized by conjunctival injection and eyelid edema and erythema. A painless, dense, whitish gray central ulcer develops slowly and may be surrounded by progressively clearer rings.
Erythema multiforme major (Stevens-Johnson syndrome).A purulent discharge characterizes Stevens-Johnson syndrome. Other ocular effects may include severe eye pain, entropion, trichiasis, photophobia, and decreased tear formation. Also typical are erythematous, urticarial, bullous lesions that suddenly erupt over the skin.
Herpes zoster ophthalmicus.Herpes zoster ophthalmicus yields a moderate to copious serous eye discharge accompanied by excessive tearing. Examination reveals eyelid edema and erythema, conjunctival injection, and a white, cloudy cornea. The patient also complains of eye pain and severe unilateral facial pain that occurs several days before vesicles erupt.
Keratoconjunctivitis sicca.Better known as dry eye syndrome, keratoconjunctivitis sicca typically causes excessive, continuous mucoid discharge and insufficient tearing. Accompanying signs and symptoms include eye pain, itching, burning, a foreign-body sensation, and dramatic conjunctival injection. The patient may also have difficulty closing his eyes.
Meibomianitis.Meibomianitis may produce a continuous frothy eye discharge. Applying pressure on the meibomian glands yields a soft, foul-smelling, cheesy yellow discharge. The eyes also appear chronically red, with inflamed lid margins.
Orbital cellulitis.Although exophthalmos is the most obvious sign of this disorder, a unilateral purulent eye discharge may also be present. Related findings include eyelid edema, conjunctival injection, a headache, orbital pain, impaired visual acuity, limited extraocular movement, and a fever.
Psoriasis vulgaris.Usually, psoriasis vulgaris causes a substantial mucus discharge in both eyes, accompanied by redness. The characteristic lesions it produces on the eyelids may extend into the conjunctiva, causing irritation, excessive tearing, and a foreign-body sensation.
Trachoma.A bilateral eye discharge occurs in trachoma along with severe pain, excessive tearing, photophobia, eyelid edema, redness, and visible conjunctival follicles.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Setting-sun sign [Sunset eyes]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Increased ICP.Transient or intermittent setting-sun sign usually occurs late in the infant with increased ICP. He may have bulging, widened fontanels, an increased head circumference, and widened sutures. He may also exhibit decreased LOC, behavioral changes, a high-pitched cry, pupillary abnormalities, and impaired motor movement as ICP increases. Other findings include increased systolic pressure, widened pulse pressure, bradycardia, changes in breathing pattern, vomiting, and seizures as ICP increases.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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