Ophthalmic Education:

Principles and Guidelines of a Curriculum for Ophthalmic Education of Medical Students: Chapter III: Cornea and External Diseases

On this page:

• Educational Goal
  
  
• Anatomy
  
  
• Red Eye
  
  
• Symptoms associated with red eye
  
  
• Steps to differentiate red eye and how to interpret findings
  
  
• Clinical Competencies

Educational Goal: 

Students should understand anterior segment anatomy of the human eye and know the signs and symptoms of common causes of red eye.  Students should also know which corneal and external related conditions require immediate referral to an ophthalmologist.

A. Anatomy

(REF. 2E Slide 59)

1. Lids.*  (REF. 2E Slide 10, 12)

a. Glands of Zeis and Moll.*

b. Lashes.*

c. Meibomian glands.*

d. Lacrimal gland.*

2. Conjunctiva.*  (REF. 2E Slide 28)

a. Bulbar.*

b. Palpebral.* 

3. Regional lymph nodes.**

a. Preauricular.**

b. Submandibular.**

4. Cornea.*  

a. Tear film.*

b. Epithelium.*

c. Stroma.*

d. Endothelium.*

5. Lacrimal system.*  

a. Punctum – upper and lower.*

b. Lacrimal sac.*

B. Red Eye.*

(REF. 2E Slides 1-6)

1. Acute angle closure glaucoma.*  (REF. 2E. Slide 83-87) (REF. 22 Fig. C01, C05, C09)

2. Iritis or iridocyclitis.* (REF. 2E. Slide 81, 82)

3. Herpes simplex keratitis.* (REF. 2E. Slide 74,75) (REF. 3 Case 13, Ocular Herpes Simplex. p. 26) (REF. 22 Fig. B06)  

4. Bacterial keratitis.* (REF. 2E Slide 76) (REF. 2C Slide 56) (REF. 22 FIG. B08)

5. Conjunctivitis.* (REF. 2E Slide 29-31, 45)  

a. Bacterial.* (REF. 2E Slide 32-34)  

b. Viral.* (REF. 2E Slide 35, 36, 74) (REF. 3 Case 2, Viral keratoconjunctivitis. p. 4) (REF. 22 Fig. B01)  

c. Allergic.* (REF. 2E Slide 37, 38) (REF. 2C Slide 53) (REF. 4 FIG 4.17) (REF. 22 FIG. B51)  

d. Neonatal.* (REF. 2E Slide 39-42, 44-46)  

e. Neonatal gonococcal.* (REF. 2E Slide 43)  

6. Episcleritis.** (REF. 2F Slide 47) (REF. 21 Fig. B50)  

7. Scleritis.** (REF. 2F Slide 48, 49, 50)  

8. Adnexal disease.*  

a. Blepharitis.* (REF. 2E Slide 15-18) (REF. 3 Case 18, Blepharitis, p.36) (REF. 21 Fig. B49)  

b. Thyroid eye disease.* (REF. 2F Slide 64-74) (REF. 22 Fig. E19, E20, E21)

c. Dacryocystitis.* (REF. 2E Slide 25)

d. Hordeolum.* (REF. 2E Slide 11) (REF. 4 FIG 4.18, 4.19) (REF. 3 Case 26, Hordeolum, p.32)

e. Chalazion.* (REF. 2E Slide 13) (REF. 22 Fig. B43, B44)

9. Subconjunctival hemorrhage versus hyphema.* (REF. 2E Slide 47) (REF. 4 FIG 5.10) (REF. 22 Fig. B38, L11)

10. Pterygium.* (REF. 2E Slide 55) (REF. 22 Fig. B29, B30)

11. Keratoconjunctivitis sicca.* (REF. 2E Slide 48-50) (REF. 22 Fig. B05)

12. Corneal abrasions and foreign body.* (REF. 2E Slide 62, 63) (REF. 2C Slide 39-42) (REF. 4 Fig. 5.7, 5.8) (REF. 22 Fig. L06)

13. Secondary to abnormal lid function.**           

a. Bell’s palsy.**

b. Thyroid ophthalmopathy.** (REF. 2F Slide 64-74) (REF. 22 Fig. E19, E20, E21)

14. Hyphema.** (REF. 2E Slide 80) (REF. 3 Case 16, Traumatic Hyphema, p.32) (REF. 22 Fig. L11)

15. Chemical injury.** (REF. 2E Slide 69, 70,71) (REF. 3 Case 24, Alkali Burn, p.48) (REF. 22 Fig. B14, B15)

C. Symptoms associated with red eye.*  

1. Blurred or decreased central visual acuity.*

2. Photophobia.*

3. Colored halos.* (REF. 2E Slide 84)

4. Discharge.*

5. Itching.*

D. Steps to differentiate red eye and how to interpret findings.* (REF. 5, Table 4.1, 4.2)

1. Measure central acuity at near.* (understand importance of reduced visual acuity)

2. Determine location of redness.*  

a. Subconjunctival hemorrhage.* (REF. 22 Fig. B38)

b. Conjunctival hyperemia (epibulbar, palpebral or both).*

c. Ciliary flush associated with corneal inflammation, iritis, and acute glaucoma.*  (REF. 4 Fig. 4.2)

3. Assess discharge and characterize.*   

a. Profuse or scant.*

b. Purulent, mucopurulent, or serous.*

4. Assess for corneal opacity associated with edema, inflammation, and ulcer.* (REF. 3)

5. Examine for corneal epithelial defect with fluorescein.*  

6. Estimate anterior chamber depth associated with acute angle closure glaucoma.* (REF. 4 Fig. 1-10)

7. Examine pupils and understand the importance of pupillary size with iritis (miotic) and acute angle closure glaucoma (mid-dilated).* (REF. 5 Table 4.1)

8. Measure intraocular pressure if elevation suspected.***  

9. Assess and detect:

a. Proptosis associated with orbital mass.*

b. Lid malfunction.*  

c. Limitation of eye movement.*  

d. Preauricular lymph node enlargement.*

Clinical Competencies

Students should:

• Measure central acuity with near card.*
• Assess corneal clarity with a penlight.*
• Assess anterior chamber depth and narrowness of angle with a penlight.*
• 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 with serious ocular conditions that require immediate ophthalmic care.*

* Basic Level: Necessary in the education of medical students worldwide.

** Standard Level: A higher level of ophthalmic understanding than the basic curriculum of most international medical students.

*** Advanced Level: Advanced cognitive and clinical skills more appropriate for students who seek further training in ophthalmology, which may be covered in an ophthalmology elective in medical school.

(Also see: More on Educational Priorities)

Next: IV. Lens and Cataract

Also see:

• Table of Contents of the "Principles and Guidelines of a Curriculum for Ophthalmic Education of Medical Students"
  
  
• Education of Medical Students in Ophthalmology
  
  
• Resources for Ophthalmic Education of Medical Students