Ophthalmic Education:

International Curriculum Guidelines on Medical Student Education in Ophthalmology: 11. Cornea and External Disease

On this page:

• i) Anatomy
  
  
• ii) The red eye*
  
  
• iii) Symptoms associated with a red eye*
  
  
• iv) Steps to differentiate the red eye and how to interpret findings*
  
  
• Competencies
  
  
• Educational Priorities

The International Council of Ophthalmology Task Force on Medical Student Education in Ophthalmology

Draft, September 16, 2003

I. Anatomy

1. Lids*
   
   1. Glands of Zeis and Moll
      
   2. Lashes
      
   3. Meibomian glands
      
   4. Lacrimal gland
2. Conjunctiva*
   
   1. Bulbar
      
   2. Palpaebral
3. Regional lymph nodes**
   
   1. Pre-auricular
      
   2. Sub-mandibular
4. Cornea*
   
   1. Tear film layer
      
   2. Epithelium
      
   3. Stroma
      
   4. Endothelium
5. Lacrimal system*
   
   1. Punctum ? upper and lower
      
   2. Lacrimal sac

II. The red eye*

1. Acute angle closure glaucoma*
   
2. Iritis or iridocyclitis*
   
3. Herpes simplex keratitis*
   
4. Conjunctivitis*
   
   1. Bacterial
      
   2. Viral
      
   3. Allergic
      
   4. Toxic
5. Epislceritis**
   
6. Scleritis**
   
7. Adnexal disease*
   
   1. Blepharitis*
      
   2. Thyroid eye disease*
      
   3. Dacryocystitis*
      
   4. Hordeolum*
      
   5. Chalazion*
8. Subconjunctival hemorrhage versus hyphema*
   
9. Pterygium*
   
10. Keratoconjunctivitis sicca*
    
11. Corneal abrasions and foreign body*
    
12. Secondary to abnormal lid function**
    
    1. Bell?s palsy
       
    2. Thyroid ophthalmolopathy

III. Symptoms associated with a red eye*

1. Blurred vision
   
2. Photophobia
   
3. Colored Haloes
   
4. Discharge
   
5. Itching

IV. Steps to differentiate the red eye and how to interpret findings

1. Measure central acuity* (understand importance of reduced visual acuity)
   
2. Determine location of redness*
   
   1. Subconjunctival hemorrhage
      
   2. Conjunctival hyperemia (epibulbar, palpaebral or both)
      
   3. Ciliary flush associated with corneal inflammation, iritis, acute glaucoma#
3. Assess discharge and characterize*
   
   1. Profuse or scant
      
   2. Purulent, mucopurulent, or serous
4. Assess for corneal opacity associated with edema, inflammation, ulcer*#
   
5. Examine for corneal epithelial defect with fluorescein*
   
6. Estimate anterior chamber depth associated with acute angle closure glaucoma*#
   
7. Examine pupils importance with iritis, acute angle closure glaucoma*#
   
8. Measure intraocular pressure if elevation suspected***
   
9. Detect presence of
   
   1. Proptosis associated with orbital mass*#
      
   2. Lid malfunction*
      
   3. Limitation of eye movement*
      
   4. Pre-auricular lymph-node enlargement*

#Denotes condition that requires immediate ophthalmologic care

(From Basic Ophthalmology for Medical Students and Primary Care Residents, edited by Bradford CA, 7th Edition, 1999, Chapter 4, 58-76)

Competencies

• Student should
  • Measure central acuity with near card
    
  • Assess corneal clarity with penlight
    
  • Assess anterior chamber depth and narrowness of angle
    
  • Assess pupil size, shape, regularity, and reactivity
    
  • Determine if redness is associated with subconjunctival hemorrhage, ciliary flush, or conjunctival hyperemia
    
  • Assess conjunctival discharge
    
  • Determine if proptosis is present
    
  • Assess ocular motility
    
  • Understand findings that are associated serious ocular conditions that require immediate ophthalmologic care

Educational Priorities

In the listing above, essential ophthalmic knowledge and clinical eye care skills are marked with a single asterisk *. This material is basic for all international medical student education.

Information that reflects a greater level of understanding is marked with two asterisks**.

Areas of cognitive and clinical skills that are more appropriate for students who seek further training in ophthalmology are marked with three asterisks***.

While important to ophthalmic care, the Task Force does not regard the cognitive or skill set designated ** or *** as essential to the basic curriculum of most international medical students.

Next: 12. Glaucoma

Also see:

• Introduction to the "International Curriculum Guidelines on Medical Student Education in Ophthalmology"
  
  
• Table of Contents for the Curriculum
  
  
• Education of Medical Students in Ophthalmology