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is commonly seen around the cornea (Fig. 14-32). This is a gray-white arc or circle around the limbus; it is due to deposition of lipid material. As more lipid accumulates, the cornea may look thickened and raised, but the arcus has no effect on vision.
are soft, raised yellow plaques occurring on the lids at the inner canthus (Fig. 14-33). They commonly occur around the fifth decade of life and more frequently in women. They occur with both high and normal blood levels of cholesterol and have no pathologic significance.
Lids are swollen and puffy. Lid tissues are loosely connected so excess fluid is easily apparent. This occurs with local infections; crying; and systemic conditions such as congestive heart failure, renal failure, allergy, hypothyroidism (myxedema)
Exophthalmos is a forward displacement of the eyeballs and widened palpebral fissures. Note "lid lag," the upper lid rests well above the limbus and white sclera is visible. Acquired bilateral exophthalmos is associated with thyrotoxicosis.
"pink eye," has red beefy-looking vessels at periphery but usually clearer around iris. This is common from bacterial or viral infection, allergy, or chemical irritation. Purulent discharge accompanies bacterial infection. Preauricular lymph node is often swollen and painful, with a history of upper respiratory infection. Symptoms include itching, burning, foreign body sensation, and eyelids stuck together on awakening.
is a deviation in the anteroposterior axis of the eye. trabismus causes disconjugate vision because one eye deviates off the fixation point. To avoid diplopia or unclear images, the brain begins to suppress data from the weak eye (a suppression scotoma). Then visual acuity in this otherwise normal eye begins to deteriorate from disuse. Early recognition and treatment are essential to restore vision.
Inside the globe, floaters appear in the vitreous as a result of debris that can accumulate because the vitreous is not continuously renewed as the aqueous humor is. Floaters are common with myopia or after middle age as a result of condensed vitreous fibers. Usually not significant, but acute onset of floaters may occur with retinal detachment.
The lower lid is loose and rolling out, does not approximate to eyeball. Puncta cannot siphon tears effectively, so excess tearing results. The eyes feel dry and itchy because the tears do not drain correctly over the corner and toward the medial canthus. Exposed palpebral conjunctiva increases risk for inflammation. Occurs in aging as a result of atrophy of elastic and fibrous tissues but may result from trauma.
The lower lid rolls in because of spasm of lids or scar tissue contracting. Constant rubbing of lashes may irritate cornea. The person feels a "foreign body" sensation.
Hordeolum is a localized staphylococcal infection of the hair follicles at the lid margin. It is painful, red, and swollen—a pustule at the lid margin. Rubbing the eyes can cause cross contamination and development of another stye.
A beady nodule protruding on the lid, chalazion is an infection or retention cyst of a meibomian gland. It is a nontender, firm, discrete swelling with freely movable skin overlying the nodule. If it becomes inflamed, it points inside and not on lid margin (in contrast with stye).
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