Patient Introduction and Review of Eye Anatomy

00:01 Next up, let's talk about a patient experiencing eye pain.

00:04 This is a 60 year old man with a history of hypertension who's presenting to the emergency department with right eye pain that started two days ago.

00:13 Now it's associated with blurry vision.

00:15 The eye is a very sensitive structure with a lot of different moving parts.

00:20 Let's review a little bit of the anatomy right here.

00:23 So first off, we divide the eyeball into an anterior chamber which is in front of and includes the lens, and then a posterior chamber which includes the vitreous and the retina.

00:34 You can notice that also lining the anterior chamber is your cornea, which once you get to the periphery of visual fields, you have the sclera wrapping around the entirety of the eyeball.

00:45 On the retina, the optic disc area is the blind spot in our vision, and it's the place with no rods or cones, which also makes it the easiest place to visualize as patients don't experience as much discomfort when we're shining light in that area.

01:01 Broad overview of things that can cause eye pain - we have external causes, internal causes, and we'll go into some more details by each of these.

01:11 And then, of course, moving away from painful causes of eye discomfort, there are also some painless manifestations that we're going to look for in the eyes as well.

01:22 Starting with external causes of eye pain, we have trauma which may be as simple as just a corneal abrasion or a patient who sustains severe trauma may experience an orbital fracture.

01:33 Infectious causes like conjunctivitis, which is very common whether bacterial, viral or allergic, and then, of course, hordeola or styes, which can be in the upper or lower eyelids.

01:43 And then many times, rheumatologic diseases may manifest in the eye with either uveitis or scleritis, or episcleritis as well.

01:54 Reviewing some of the internal causes of eye pain, a normal eye is depicted here, contrasting that with open angle glaucoma, which tends to be painless.

02:04 But the painful process, closed angle glaucoma is an ophthalmologic emergency.

02:15 And then moving farther back in the skull, we have elevated intracranial pressure, which can also cause headaches, whether caused by a brain tumor, occluding the fourth ventricle or patients who have pseudotumor cerebri can also have elevated intracranial pressure.

02:31 And we would be able to visualize that, looking at the back of the eye, looking for papilledema.

02:36 And looking at more benign causes of eye pain, there are particular headache subtypes which can manifest with eye pain, in particular cluster headaches.

02:45 Simply patients who have the flu may have retroorbital pain.

02:48 And then certainly migraines can present with unilateral frontal pain as well.

02:54 So with all those different possibilities in mind, we're going to have to do a thorough exam.

02:58 We're going to be thinking about glaucoma, whether closed angle or open angle.

03:02 We're looking for signs of conjunctivitis, uveitis, corneal abrasions.

03:07 And also maybe this is not an eye problem at all.

03:10 And just a cluster headache would be a diagnosis of exclusion.