EYE

EXAMINATION

BY:
Gita Amalia Asikin
I11112032
SUPERVISOR:
dr. Muhammad Asroruddin, Sp.M
 Steps in Basic Eye Examination
1.  Visual Acuity 7.  Lens clarity
2.  Pupillary examination 8.  Tonometry
3.  Visual fields by 9.  Fundus examination
confrontation 1.  Disc
4.  Extraocular movements 2.  Macula
3.  Vessels
5.  Inspection of
1.  Lids and surrounding tissue
2.  Conjunctiva and sclera
3.  Cornea and iris
6.  Anterior chamber depth

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 VISUAL ACUITY

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 Snellen eye chart

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 Visual Acuity Testing
  Nomenclature:
Distance between the pa<ent and the eye chart

Distance at which the le@er can be read by a person with normal acuity

Snellen (m) Snellen (Ft) Decimal

6/6 20/20 1.0

5/6 20/25 0.8
6/9 20/30 0.7
5/9 15/25 0.6
6/12 20/40 0.5
5/12 20/50 0.4
6/18 20/70 0.3
6/60 20/200 0.1
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Cont…
Place patient at 6 m from Snellen chart and close
one eye that is not tested.
•  VA is line in which > ½ letters are read
•  Average normal VA  6/4 – 6/6 m (20/15 –
20/20 ft)
•  6/6 = patient can read at 6 m with same
accuracy as person with normal vision.
•  6/60= patient can read at 6 m what normal
person can read from 60 m.
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 Cont…
•  Can’t read at 6/60  Count fingers
–  Examiner moves until 5 m away from patient  patient
can identify the number of fingers  VA = 5/60
–  If still can’t  move 1 m forward each time and try
again until examiner is 1 m away from patient.
•  Can’t identify the number of fingers at 1/60 
Hand motion
–  VA = 1/300
•  Can’t see the hand motion  Light perception
–  Yes  VA = 1/~
–  No  VA = 0
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 Pinhole Test
•  Determine if a problem with acuity is the result of
refractive error (and thus correctable with glasses) or
due to organic disease.
–  Better  Refractive error
–  Same/worse  Organic disease

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 Refractive Error Correction
•  Determine the distance between right pupil and
left pupil (PD)
–  Hold a ruler in front of the eyes.
–  Light between the eyes from >30 cm (distance PD)
and 30 cm (near PD). See the light reflex on each
cornea’s eye.
–  Measure the distance between those light reflex.

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Cont…
•  Determine the power of sefris lens (dioptre)
–  Put on trial frame at the right position (distance PD)
–  Put on the occluder in front of the eye that won’t be
tested yet
–  Ask patient to see the Snellen Chart
–  Put on the trial lens (S- or S+ lens) and add the lens’
power until patient gets the best vision.
–  If myopia  choose the lowest S- lens that can give the
best visual acuity
–  If hypermetropia  choose the highest S+ lens

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0
Cont…
•  If presbyopia
–  Use near PD
–  Choose S+ lens according patient’s age
•  40 y.o. S+1.00
•  45 y.o. S+1.50
•  50 y.o. S+2.00
•  55 y.o. S+2.50
•  60 y.o. S+3.00
–  Try to read from the right distance for reading
(+30cm)

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1
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 PUPILLARY EXAMINATION

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 Pupillary Examination
Describe PRRA
Pupils Equal
•  Insokor or anisokor
•  d normal = 3-5 mm, <2 mm = myosis, >5 mm
= mydriasis
Round
•  Draw pupils if they’re not round/irregular

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 Pupillary Examination Technique
Reactive to Light
•  Direct penlight into eye while patient looking at
distance
–  Direct
•  Constriction of ipsilateral eye
–  Consensual
•  Constriction of contralateral eye

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Cont…
Accomodation
•  Patient’s eyes follow examiner’s finger brought in
towards them, directly in middle
–  The eyes should converge and the pupils will
constrict (accommodation)

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 VISUAL FIELDS BY
CONFRONTATION

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• Ask the pt to cover one eye
• Cover your opposite eye
• Ask the pt to look straight ahead
• P lace one hand in the plane
be t w e e n t he pat ie nt and t he
examiner out of your vision
• Move the hand and ask the patient
when he/she can see your hand

Both eyes should be checked for

stimulation simultaneously.

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 EXTRAOCULAR MOVEMENTS

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 Extraocular Muscles and Direc<on of Movement

•  Ask the pt to hold his/her head still and to follow your finger
with their eyes
•  Eye movement dependent on Cranial Nerves 3, 4, and 6 &
muscles they innervate.
•  SO ‘4’, LR ‘6’, All the rest ‘3’
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 INSPECTION

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 Inspects external ocular (eye) structures (lids, conjunctiva, iris,
cornea, pupils)
Gently moves eyelids up and down to obtain a better view
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 Observation External Structures
• Pupil, iris and eyelids & lashes should appear
symmetric
• Sclera should be white
• Conjunctiva clear

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 ANTERIOR CHAMBER DEPTH

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•  Shine a light from the temporal side of the head
across the front of the eye parallel to the plane
of the iris.
•  Look at the nasal aspect of the iris. If two thirds
or more of the nasal iris is in shadow, the
chamber is probably shallow and the angle
narrow.

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 LENS CLARITY

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•  Light pupil from the front. See the colour of the
pupil.
–  Pupil is black
•  Clear lens
•  Aphakia
–  Pupil is white or grey : unclear/cataract
•  Light iris from the temporal side of the eye (about
45o angle from the horizontal line of iris). See the
pupils again!
–  Pupil still white  mature cataract (shadow test (-))
–  Pupil turns into black  immature cataract (shadow test
(+))

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 TONOMETRY

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 Digital Tonometry
•  Palpation (also known as digital tonometry) is
the method of estimating intraocular pressure by
gently pressing the index finger against the
cornea of a closed eye.

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 Schiotz Tonometry
•  Instil local anaesthetic eye drops and wait about 30
seconds.
•  Ask the patient to look at a fixed object and to keep
absolutely still.
•  With the thumb and index finger of one hand, gently
hold open the patient's eyelids, taking care not to put any
pressure on the eye.
•  With the other hand, hold the tonometer between the
thumb and index finger and place the plunger on the
central cornea.
•  Allow the disc to lower gently onto the corneal surface.
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 FUNDUS EXAMINATION

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 Direct Opthalmoscope

Holding the Opthalmoscope

Use the index finger to change lenses (diopters)

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 •Darken the room
• Place the opthalmoscope to 0 diopters
• Keep index finger on lens disc
• Use R hand for pt’s R eye and L hand for
pt’s L eye
•Ask pt to fix gaze on a spot on the wall
• Observe the red reflex and then move in
closer
• You may rest your opposite hand on the pt’s
forehead above the eye to help guide
•Move the opthalmoscope very close to the
pt’s eye
•If you initially see blood vessels, you can
follow the blood vessels toward the disc.
•Diopters may need to be adjusted to obtain a
good focus
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 The Retina (fully viewed)
Temporal Optic Disc Optic Cup Nasal
Structures To Note:
1. Color of retina
(orange-ish)
2. Arteries (smaller)
3. Veins (darker)
4. Optic Disc (head of
CN2)
5. Optic Cup (center of
disc)
6. Macula (sharpest
focus) – center =‘s
fovea

Macula Artery Vein

Fovea

• The cup-to-disc ratio should be less than 0.6.

• Arterioles should be 2/3 to 4/5 the size of veins.
•Next look in all 4 quadrants of the retina
• Finally, look at the fovea and macula. This may be accomplished by asking the pt to
look at the light
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 ANEL TEST

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 FLUORESEIN TEST

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 ISHIHARA PLATES

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 EYELID EVERSION

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 THANK YOU

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