Name _________________________

8-part Eye Exam Checklist

1. Distance Visual Acuity

Yes No
Ask the patient to stand or sit at a designated testing distance (20 feet)
Occlude the left eye (testing one eye at a time)
Ask the patient to identify each letter in the chart, on the lines of successively
smaller optotypes, until patient correctly identifies only half the optotypes on
a line
Note the corresponding acuity measurement shown at the line of the chart
Repeat above steps for the left eye, with the right eye covered
Retest acuity with the patient using both eyes simultaneously
Enumerate the steps in testing visual acuity of patients with low vision, e.g.
counting fingers, hand motion, light perception, etc.

2. External Exam
Observe the facial skin for any dermal or vascular changes; note any lesions or
evidence of trauma
Note any significant asymmetry of facial bones
Note the lid position; assess effectiveness of eyelid closure and strength of the
orbicularis muscles if appropriate
Palpate the bony orbit for any lesion or deformity

3. Pupillary Exam
Turn off the light to decrease the room illumination
Ask the patient to maintain fixation on a distance target
Shine a bright handheld light directly into the right eye by approaching it from
the side or from below
Record the direct pupillary response to light in the right eye in terms of
briskness of the response; observe the consensual reflex by noting the
response to light of the non-illuminated pupil
Repeat above steps for the left eye
Enumerate the steps in performing the swinging flashlight test and explain the
clinical significance of relative afferent papillary defect (Marcus-Gunn pupil)

4. Motility Examination
Sit facing the patient. Hold finger or small fixation target at eye level about 10-
14 inches in front of the patient, with the patient looking straight ahead
Ask the patient to follow the target as you move it into the six cardinal fields
and up and down along the midline. Elevate the upper eyelid with a finger on
your free hand to observe downgaze

Note whether the amplitude of eye movements is normal or abnormal in both

eyes
Note any nystagmus that may be present
Determine alignment using the Hirschberg method of corneal light reflection
test - hold a penlight in front of the patient’s eyes at a distance of
approximately 2 feet, directing the light at the midpoint between the two eyes
of the patient; instruct the patient to look directly at the light; compare the
position of the two corneal light reflections and record the estimated result

5. Visual fields (Confrontation Test)

Seat the patient and make sure the eye not being tested is occluded
Seat facing the patient at a distance of about 1 m. Close your eye that is
directly opposite the patient’s occluded eye
Ask the patient to fixate on your nose or on your open eye
Hold your hands stationary midway between yourself and the patient in
opposite quadrants about 30 degrees from central fixation
Quickly extend then retract a finger or fingers on one hand in one quadrant of
the monocular field asking the patient to state the number of fingers seen
Repeat in all four quadrants, testing at least twice per quadrant
Diagram the confrontation field if an abnormality is detected

6. Tonometry
Enumerate and differentiate the methods of measuring intraocular pressure (5
points - 2 points for enumerating and 3 points for differentiating the methods)

7. Ophthalmoscopy (Direct)
Position the patient about 2 feet away
Turn off the light to dim the room illumination
Set the focusing lens of the ophthalmoscope to zero
Check the red reflex from a distance of two feet
Approach the patient’s eye; the instrument is steadied against the patient’s
face by resting the ulnar border of the hand holding the instrument against the
patient’s cheek; the thumb of the free hand raises the upper eyelid
Instruct the patient to stare into the distance
Dial the ophthalmoscope’s focusing lenses into place to clarify the fundus
image
Find the optic disc by following a retinal blood vessel
Examine the peripapillary retina
From the optic disc, follow the blood vessels outward to examine the four
quadrants around the posterior pole
Check for the foveal reflex

8. Slit-lamp Biomicroscopy
Identify the different parts of a slit-lamp biomicroscope (2 POINTS)
Enumerate the different uses of the slit-lamp – Give 3 uses (3 POINTS)