Facial Visual Inspection in Medical Assessment

I. General Impression and Overall Symmetry

• Overall Facial Appearance: Does the patient look their stated age? General impression of health or illness?
• Symmetry: Is the face symmetrical at rest and with movement (e.g., smiling, frowning, raising eyebrows)? Asymmetry can indicate neurological issues (e.g., Bell's Palsy, stroke), trauma, or congenital conditions.
• Expression/Affect: Is the patient's facial expression appropriate for the situation? Does it convey pain, anxiety, sadness, or flat affect?
• Head Position: Is the head held upright and centered? Any tilt or unusual posture?
• Involuntary Movements: Are there any tics, tremors, spasms, or other involuntary facial muscle movements?

II. Skin and Hair

Color

• Pallor: Suggests anemia or poor circulation.
• Cyanosis: Bluish discoloration, especially around the lips, indicates poor oxygenation.
• Jaundice: Yellowish tint, especially in the sclera, indicates liver dysfunction.
• Erythema: Redness, can suggest inflammation or fever.
• Hyperpigmentation/Hypopigmentation: Darker or lighter skin patches.
• Flushing: Transient redness from fever, emotions, or conditions.

Other Characteristics

• Lesions: Cuts, bruises, rashes, moles (note size, shape, color, border, changes), tumors.
• Texture and Moisture: Is the skin dry, oily, rough, or smooth?
• Turgor: Pinch test for hydration status.
• Hair Distribution: Note hirsutism or alopecia patterns.
• Edema: Puffiness, especially periorbital, indicating systemic issues.

III. Eyes

Periorbital Area

• Edema: Swelling around the eyes.
• Discoloration: Dark circles, bruises.
• Lesions: Styes, chalazions.

Eyelids

• Ptosis: Drooping eyelid(s), possible neurological origin.
• Ectropion/Entropion: Lid turning outward or inward.
• Lid Lag: Sign of thyroid disease.

Conjunctiva

• Pallor: Suggests anemia.
• Redness/Injection: Irritation, allergy, or infection.
• Discharge: Pus or watery fluid.

Sclera

• Jaundice: Yellowing.
• Blue Sclera: May indicate osteogenesis imperfecta.

Cornea and Lens

• Check for clarity, opacities, or arcus.

Pupils

• Size, Shape, Symmetry: PERRLA - Pupils Equal, Round, Reactive to Light and Accommodation.
• Anisocoria: Unequal pupil size.

Extraocular Movements

• Assess in six cardinal directions for coordination, nystagmus, or diplopia.

IV. Nose

• Shape and Symmetry: Look for deformities or septal deviation.
• Nostrils: Flaring, discharge (clear, purulent, or bloody).
• Lesions: Sores, scabs, or growths.

V. Mouth and Lips

Lips

• Color: Pallor, cyanosis, cherry-red appearance.
• Symmetry: Any drooping or unevenness?
• Lesions: Cheilosis, herpes, ulcers, nodules.

Oral Mucosa

• Color: Should be healthy pink.
• Lesions: Ulcers, white patches (leukoplakia), fungal infection (thrush).
• Hydration: Dryness may indicate dehydration.

Tongue

• Inspect for color, coating, size, surface changes (fissures, tremors, glossitis).

Teeth and Gums

• Dentition: Missing teeth, dentures, malalignment.
• Hygiene: Cavities, plaque.
• Gums: Redness, swelling, bleeding.

VI. Ears

Auricles (Outer Ear)

• Shape, Size, Symmetry: Note abnormalities.
• Tophi: Uric acid deposits in gout.
• Growths: Skin tags, lesions.

Pre/Postauricular Area

• Check for swelling or tenderness (mastoiditis, lymphadenopathy).

VII. Jaw and Neck (Facial Relevance)

• Temporomandibular Joint (TMJ): Check for swelling, clicking, crepitus during movement.
• Mandible/Maxilla: Look for deformities or swelling.

VIII. Specific Facial Characteristics Associated with Conditions