STUDY - Technical - New Dacian's Medicine
Eye
pain (ophthalmalgia) (Classical / Allopathic Medicine)
Eye pain
(ophthalmalgia) may be described as a burning, throbbing,
aching, or stabbing sensation in or around the eye. It may
also be characterized as a foreign-body sensation. This sign
varies from mild to severe; its duration and exact location
provide clues to the causative disorder.
Eye pain usually
results from corneal abrasion, but it may also be due to
glaucoma or another eye disorder, trauma, or a neurologic or
systemic disorder. Any of these may stimulate nerve endings in
the cornea or external eye, producing pain.
Examining the
external eye
For the patient with eye pain or other ocular symptoms, examination of the external eye forms an important part of the ocular assessment. Here's how to examine the external eye.
First, inspect the eyelids for ptosis and incomplete closure. Also, observe the lids for edema, erythema, cyanosis, hematoma, and masses. Evaluate skin lesions, growths, swelling, and tenderness by gross palpation. Are the lids everted or inverted? Do the eyelashes turn inward? Have some of them been lost? Do the lashes adhere to one another or contain a discharge? Next, examine the lid margins, noting especially any debris, scaling, lesions, or unusual secretions. Also, watch for eyelid spasms.
Now gently retract the eyelid with your thumb and forefinger, and assess the conjunctiva for redness, cloudiness, follicles, and blisters or other lesions. Check for chemosis by pressing the lower lid against the eyeball and noting any bulging above this compression point. Observe the sclera, noting any change from its normal white color.
Next, shine a light across the cornea to detect scars, abrasions, or ulcers. Note any color changes, dots, or opaque or cloudy areas. Also, assess the anterior eye chamber, which should be clean, deep, shadow-free, and filled with clear aqueous humor.
Inspect the color, shape, texture, and pattern of the iris. Then assess the pupils’ size, shape, and equality. Finally, evaluate their response to light. Are they sluggish, fixed, or unresponsive? Does pupil dilation or constriction occur only on one side?
ALERT:
If the patient's eye pain is a result of a chemical burn:
- remove his contact lenses, if present, and irrigate the eye with at least 1 qt (1 L) of normal saline solution over 10 minutes
- evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals.
If the patient's eye pain isn't the result of a chemical burn, perform a focused assessment.
For the patient with eye pain or other ocular symptoms, examination of the external eye forms an important part of the ocular assessment. Here's how to examine the external eye.
First, inspect the eyelids for ptosis and incomplete closure. Also, observe the lids for edema, erythema, cyanosis, hematoma, and masses. Evaluate skin lesions, growths, swelling, and tenderness by gross palpation. Are the lids everted or inverted? Do the eyelashes turn inward? Have some of them been lost? Do the lashes adhere to one another or contain a discharge? Next, examine the lid margins, noting especially any debris, scaling, lesions, or unusual secretions. Also, watch for eyelid spasms.
Now gently retract the eyelid with your thumb and forefinger, and assess the conjunctiva for redness, cloudiness, follicles, and blisters or other lesions. Check for chemosis by pressing the lower lid against the eyeball and noting any bulging above this compression point. Observe the sclera, noting any change from its normal white color.
Next, shine a light across the cornea to detect scars, abrasions, or ulcers. Note any color changes, dots, or opaque or cloudy areas. Also, assess the anterior eye chamber, which should be clean, deep, shadow-free, and filled with clear aqueous humor.
Inspect the color, shape, texture, and pattern of the iris. Then assess the pupils’ size, shape, and equality. Finally, evaluate their response to light. Are they sluggish, fixed, or unresponsive? Does pupil dilation or constriction occur only on one side?
ALERT:
If the patient's eye pain is a result of a chemical burn:
- remove his contact lenses, if present, and irrigate the eye with at least 1 qt (1 L) of normal saline solution over 10 minutes
- evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals.
If the patient's eye pain isn't the result of a chemical burn, perform a focused assessment.
HISTORY:
Ask the patient when the pain began.
Ask the patient to fully describe the pain. Is it an ache or a sharp pain? Is it accompanied by burning or itching? How long does it last? Is it worse in the morning or late in the evening?
Ask the patient about recent trauma or surgery, especially if he complains of sudden, severe pain.
Ask the patient if he has headaches. If he does, find out how often and at what time of day they occur.
Ask the patient when the pain began.
Ask the patient to fully describe the pain. Is it an ache or a sharp pain? Is it accompanied by burning or itching? How long does it last? Is it worse in the morning or late in the evening?
Ask the patient about recent trauma or surgery, especially if he complains of sudden, severe pain.
Ask the patient if he has headaches. If he does, find out how often and at what time of day they occur.
PHYSICAL
ASSESSMENT:
Don't manipulate the eye if you suspect trauma. Carefully assess the lids and conjunctivae for redness, inflammation, and swelling. (See Examining the external eye.)
Examine the eyes for ptosis or exophthalmos.
Test visual acuity with and without correction, and assess extraocular movement.
Characterize any discharge.
Don't manipulate the eye if you suspect trauma. Carefully assess the lids and conjunctivae for redness, inflammation, and swelling. (See Examining the external eye.)
Examine the eyes for ptosis or exophthalmos.
Test visual acuity with and without correction, and assess extraocular movement.
Characterize any discharge.
SPECIAL
CONSIDERATIONS:
Remember to ask a patient suffering from eye pain if he wears contact lenses; they may cause a foreign body sensation and be the source of the pain.
Remember to ask a patient suffering from eye pain if he wears contact lenses; they may cause a foreign body sensation and be the source of the pain.
PEDIATRIC
POINTERS:
Trauma and infection are the most common causes of eye pain in children.
Be alert for nonverbal clues to pain, such as tightly shutting or frequently rubbing the eyes.
Trauma and infection are the most common causes of eye pain in children.
Be alert for nonverbal clues to pain, such as tightly shutting or frequently rubbing the eyes.
AGING ISSUES:
Glaucoma, which can cause eye pain, is usually a disease of older patients, becoming clinically significant after age 40. It most commonly occurs bilaterally and leads to slowly progressive visual loss, especially in peripheral visual fields.
Glaucoma, which can cause eye pain, is usually a disease of older patients, becoming clinically significant after age 40. It most commonly occurs bilaterally and leads to slowly progressive visual loss, especially in peripheral visual fields.
PATIENT
COUNSELING:
To help ease eye pain, tell the patient to lie down in a darkened, quiet room and close his eyes. Remind the patient not to rub his eyes, even if he feels a foreign body sensation.
To help ease eye pain, tell the patient to lie down in a darkened, quiet room and close his eyes. Remind the patient not to rub his eyes, even if he feels a foreign body sensation.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)