Chapter 52: Evaluation of the Eyes Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A provider performs an eye examination during a health maintenance visit and notes a difference of 0.5 mm in size between the patient’s pupils. What does this finding indicate?

a. A relative afferent pupillary defect b. Indication of a difference in intraocular pressure c. Likely underlying neurological abnormality d. Probable benign, physiologic anisocoria

ANS: D a. Order lubricating drops or ointments. b. Prescribe ophthalmic antibiotic drops. c. Reassure the patient that this will resolve. d. Refer to an ophthalmologist.

A difference in diameter of less than 1 mm is usually benign. Afferent pupillary defects are paradoxical dilations of pupils in response to light. This does not indicate differences in intraocular pressure. A difference of more than 1 mm is more likely to represent an underlying neurological abnormality.

2. A patient comes to clinic with diffuse erythema in one eye without pain or history of trauma. The examination reveals a deep red, confluent hemorrhage in the conjunctiva of that eye. What is the most likely treatment for this condition?

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ANS: C a. Normal physiologic variant b. Ocular disease requiring referral c. Potential infection in the “red” eye d. Potential vision loss in one eye

Most subconjunctival hemorrhage, occurring with trauma or Valsalva maneuvers, will self-resolve and are benign. Lubricating drops are used for chemosis. Antibiotic eye drops are not indicated. Referral is not indicated.

3. During an eye examination, the provider notes a red-light reflex in one eye but not the other. What is the significance of this finding?

ANS: B

The red reflex should be elicited in normal eyes. Any asymmetry or opacity suggests ocular disease, potentially retinoblastoma, and should be evaluated immediately.