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Eye Examination

The document outlines the key steps in performing an eye examination, including assessing visual acuity, extraocular eye movements, pupillary reaction, anterior segment inspection, intraocular pressure measurement, and fundus examination. Visual acuity is tested at both near and distance using an eye chart. Extraocular movements, pupil reaction to light, and anterior segment structures are evaluated. Intraocular pressure is measured using techniques like Schiotz tonometry. A dilated fundus exam of the retina and optic disc is also performed.

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cynthia167
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216 views

Eye Examination

The document outlines the key steps in performing an eye examination, including assessing visual acuity, extraocular eye movements, pupillary reaction, anterior segment inspection, intraocular pressure measurement, and fundus examination. Visual acuity is tested at both near and distance using an eye chart. Extraocular movements, pupil reaction to light, and anterior segment structures are evaluated. Intraocular pressure is measured using techniques like Schiotz tonometry. A dilated fundus exam of the retina and optic disc is also performed.

Uploaded by

cynthia167
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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The Eye

Examination

ANATOMY

Anatomy

Extraocular
movements

Medial
Lateral
Upward
Downward

Visual Acuity

General physical examination should include :

Visual acuity
Pupillary reaction
Extraocular movement
Direct ophthalmoscope
Dilated exam (in case of visual loss or retinal
pathology)

Distance or Near
Distance visual acuity at age 3

early detection of amblyopia

Distance Visual Acuity


Testing

VA - Visual acuity
OD - ocular dexter
OS - ocular sinister
OU - oculus uterque

20/20 (6/6;5/5,1.0)

Distance between the patient and the eye chart


_____________________________________________
Distance at which the letter can be read by a person with
normal acuity

Distance Visual Acuity


Testing

Place patient at 20 ft (6m) from


Snellen chart
OD then OS
VA is line in which > letters are
read
Pinhole if < 20/20 or < 6/6

Snellen eye
chart

Rosenbaum
pocket chart

Distance Visual Acuity


Testing

If VA < 20/400 or < 6/60

Reduce the distance between the pt and


the chart and record the new distance (eg.
5/400)

If < 5/400 (< 6/60)


CF (include distance)
HM (include distance)
LP
NLP

Near Visual Acuity


Testing

Usually done when


Patient complains about near vision
Distance testing difficult/impossible

But after check the distance we have


to check the near acuity also
Distance specified on each card
(35cm)

Anterior Segment
Inspection of:
Eyelids
Conjunctiva and sclera
Cornea
Anterior chamber
Iris
Pupil
lens

Anterior chamber depth


assessment

Likely shallow if

2/3 of nasal iris


in shadow

Pupillary Examination

Direct penlight into eye while


patient looking at distance

Direct

Constriction of ipsilateral eye

Consensual

Constriction of contralateral eye

Ocular Motility
Rt superior rectus
Lt inferior oblique

Lt superior rectus
Rt inferior oblique

Rt lateral rectus
Lt medial rectus

Lt lateral rectus
Rt medial rectus

Rt inferior rectus
Lt superior
oblique

Lt inferior rectus
Rt superior
oblique

Direct Ophthalmoscopy

Tropicamide or phenylephrine for dilation


unless shallow anterior chamber
unless under neurological evaluation

Use own OD to examine OD with Right


hand to hold the ophthalmoscope

Same for OS

Posterior Segment
Direct Ophthalmoscopy

Evaluated:
1. Papil Nervus Opticus
2. Blood Vessel of Retina (arteri vein
ratio, bleeding, vena
microaneurysm)
3. Retina (subhyaloid bleeding, dot
blot, flame shape, oedem macula)

Intraocular Pressure
Measurement

Range: 10 22
Gold standard: Goldmann Aplanation
tonometry
More simple device for GP:

Digital palpation of IOP


Schiotz tonometry

Schiotz toometry
Aplanation
tonometry

Non Contact

Schiotz Tonometry

callibaration

Summary of steps in eye


exam

Visual Acuity
Visual fields ( confrontation )
Extraocular movements
Inspection of anterior Segment

lid and surrounding tissue, conjunctiva and


sclera,cornea, anterior chamber, iris, Pupillary
examination, Lens clarity

Tonometry (Schiotz, Digital palp)


Fundus examination

Fundus reflex, Optic Nerve (Cup &Disc ratio, margin,


color), vitreous, vessels and macula

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