Observe the eyes and the tissues around the eyes for any abnormalities. The tissue surrounding the eye is a common area to find lesions associated with sun damage such as basal cell carcinoma. Always remove the patient’s glasses. Metal frames increase sun damage around the eye area which could lead to skin cancer.

Pay close attention to the color of the sclera and the size of the pupils (Figure 10).

Figure 10. Observe the eyes for any abnormalities.
Observe the eyes for any abnormalities

Yellow sclera is associated with jaundice and may indicate an undiagnosed case of hepatitis (A or B), other liver dysfunction or a blood disorder. Blue sclera is associated with osteogenesis imperfecta which may include alteration of the structure of dentin. Pupil size may help identify patients who are at risk for medical emergencies due to illegal drug use. Lesions such as symblepharon or pterygium may affect the sclera. Symblepharon is a partial or complete adhesion of one or both eyelids to the eyeball associated with benign mucous membrane pemphigoid, lichen planus, and trauma such as burns. Pterygium is an excessive growth of the conjunctiva which begins to cover portions of the sclera potentially obstructing vision. A referral to a specialist such as an ophthalmologist is needed to assess any condition exhibiting symblepharon or pterygium.