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Ophthalmologic Clues to Infectious Diseases
and Their Mimics in Critical Care
Cheston B. Cunha
Department of Medicine, Brown University, Alpert School of Medicine, Providence, Rhode Island, U.S.A.Michael J. Wilkinson
Department of Ophthalmology, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, U.S.A.David A. Quillen
Department of Ophthalmology, George and Barbara Blankenship, Pennsylvania State University, College of
Medicine, Hershey, Pennsylvania, U.S.A.The eyes, like a sentinel, occupy the highest place in the body.
—Marcus Tulius Cicero
Eye exam is one element of physical examination that is frequently overlooked by
clinicians despite its ability to provide key diagnostic clues. Often an eye exam is deferred
because of a lack of comfort or familiarity with funduscopic and, to a lesser degree, external
ocular examination. However, clinicians should take time to carefully inspect the internal and
external anatomy of the eye in search of a physical finding that may tip the scales toward one
diagnosis over another.
Nowhere is this more the case than in critically ill patients, who are often unable to
provide historical clues as to the nature of their condition. We should, therefore, not relegate
this exam solely to the purview of ophthalmologists, but rather add it to our armamentarium
of diagnostic tools.
This chapter, presented in tabular form, contains a collection of both internal and
external eye findings in conditions that may be seen in an intensive care setting. This is
designed to act as a guide to supplement the internists ocular exam of critically ill patients—to
be used for initial evaluation of a patient or when an ophthalmologist is not readily available.
These findings, in concert with the history, physical, and laboratory analyses, may help to
identify the etiology of the patient’s illness (1–4).
Note that physical findings that will be visible on slit lamp exam will be found under
“SL:” All other findings should be visible on general examination of the eye.