CLINICAL METHODS IN OPHTHALMOLOGY

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RECORD OF OPHTHALMIC CASE

Both right and left eye should be examined and findings should be recorded in ophthalmic clinical case sheet (Appendix I, page 496).

TECHNIQUES OF OCULAR EXAMINATION AND DIAGNOSTIC TESTS

OBLIQUE ILLUMINATION

alcohol, acetone or by heating the footplate in the flame of spirit. After anaesthetising the cornea with 2-4 per cent topical xylocaine, patient is made to lie supine on a couch and instructed to fix at a target on the ceiling. Then the examiner separates the lids with left hand and gently rests the footplate of the tonometer vertically on the centre of cornea. The reading on scale is recorded as soon as the needle becomes steady (Fig. 21.13).

See page 543

TONOMETRY

The intraocular pressure (IOP) is measured with the help of an instrument called tonometer. Two basic types of tonometers available are: indentation and applanation.
Indentation tonometery

Indentation (impression) tonometry is based on the fundamental fact that a plunger will indent a soft eye more than a hard eye. The indentation tonometer in current use is that of Schiotz, who devised it in 1905 and continued to refine it through 1927. Because of its simplicity, reliability, low price and relative accuracy, it is the most widely used tonometer in the world. Schiotz tonometer. It consists of (Fig. 21.12): Handle for holding the instrument in vertical position on the cornea; Footplate which rests on the cornea; Plunger which moves freely within a shaft in the footplate; Bent lever whose short arm rests on the upper end of the plunger and a long arm which acts as a pointer needle. The degree to which the plunger indents the cornea is indicated by the movement of this needle on a scale; and Weights: a 5.5 g weight is permanently fixed to the plunger, which can be increased to 7.5 and 10 gm. Technique of Schiotz tonometry. Before tonometry, the footplate and lower end of plunger should be sterilized. For repeated use in multiple patients it can be sterilized by dipping the footplate in ether, absolute

Fig. 21.12. Schiotz tonometer.

It is customary to start with 5.5 gm weight. However, if the scale reading is less than 3, additional weight should be added to the plunger to make it 7.5 gm or 10 gm, as indicated; since with Schiotz tonometer the greatest accuracy is attained if the deflection of lever is between 3 and 4. In the end, tonometer is lifted and a drop of antibiotic is instilled. A conversion table is then used to derive the