Inspect the Eyes

The presence of yellowish plaques on the eyelids, called xanthelasma, should raise the suspicion of an underlying hyperlipoproteinemia, even though this lesion is less specific than the xanthoma. Xanthelasma in a patient with hypercholesterolemia is shown in Figure 14-18.

Examination of the eyes may reveal an arcus senilis. An arcus (see Figs. 10-53 and 10-54) seen in a patient younger than 40 years should raise the suspicion of hypercholesterolemia. Opacities in the cornea may be evidence for sarcoidosis, which may be responsible for cor pulmonale or myocardial involvement. Displacement of the lens is frequently seen in patients with Marfan's syndrome, an important cause of aortic regurgitation (see Fig. 10-69). Conjunctival hemorrhages are commonly seen in infective endocarditis. Hypertelorism, or widely set eyes, is often associated with congenital heart disease, especially pulmonic stenosis and supravalvular aortic stenosis. Retinal evaluation may furnish valuable information about diabetes (see Figs. 10-88 to 10-100), hypertension (see Figs. 10-101 to 10-105), and atherosclerosis. Roth's spots may develop in patients with infective endocarditis (see Fig. 10-109).

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