The Intraoral and Extraoral Exam
Eyes

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. The rise in thyroid disease is noted in statistical data and thyroid eye implications are to be referred to a specialist. Other oral signs should be evaluated such as indications of pemphigoid affecting the eye and other systemic conditions that may be noted or that are suspicious.^1,2,3

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

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. A recent focus on complaints of the eye such as excessive tearing, irritation and dryness have been associated with thyroid eye disease and may be a consideration when patients exhibit these signs. There is a notable increase in thyroid disease and thyroid cancer.