Davao Medical School Foundation, Inc

ARTS AND SCIENCE OF MEDICINE 2

RATING SCALE FOR EXAMINATION OF

EYE EXAMINATION

Name of Student: _____________________________________________ Date:

__________
Legend: 3 points = Done COMPLETELY and CORRECTLY
2 points = Done CORRECTLY but INCOMPLETE
1 point = Done INCORRECTLY and INCOMPLETE
1 point= NOT DONE

A. ESTABLISHING RAPPORT 3 2 1 0 REMARKS

1. Washes hands before and after

the examination.
2. Greets the patient politely
3. Introduces Self
4. Asks the patient’s NAME, AGE,
CIVIL STATUS, OCCUPATION,
ADDRESS
5. Explains the
examination/procedure
6. Asks the patient’s consent and
permission to do the procedure
B. VISUAL ACUITY TESTING
7. Position the patient 20 feet from
the chart
8. If the patient has glasses, make
sure that the patient wears his
glasses
9. Ask the patient to cover one eye
with a card
10. Let the patient read from the top
of the chart until the smallest
line of letter he can read
11. Asks the patient to do the same
in the other eye
C. VISUAL FIELDS TESTING (STATIC FINGER WIGGLE TEST)
12. Instructs the patient to tell you if
he already sees the fingers
while doing the test
13. Let the patient stand in front of
you
14. Asks the patient to look with
both eyes into the examiner’s
eyes
15. Places hands 2 feet apart,
lateral to the patient’s ear

3 2 1 0 REMARKS

16. Wiggles both fingers

simultaneously
17. Brings both fingers forward
while wiggling, curving inward
along the imaginary surface of
the bowl toward the central
vision line
 18. Asks the patient if he or she
sees the finger movement every
time he brings the finger forward
D. POSITION AND ALIGNMENT OF THE EYES AND OTHER PARTS OF THE EYE
19. Stands in front of the patient
20. Survey the eyes for position and
alignment with each other.
21. Inspects eyebrow
22. Inspects eyelids
23. Inspects lacrimal apparatus
24. Inspects conjunctiva
25. Inspects sclera
26. Inspects cornea
27. Inspects iris
E. EXAMINATION OF PUPIL
28. Inspect the size of the pupils.
If the pupils are large (>5 mm),
small (<3 mm), or unequal,
measure them.
29. Inspect the shape of the pupils.
30. Inspect the symmetry of the
pupils.
F. TEST THE PUPILLARY REACTIONS TO LIGHT
31. Asks the patient to look into the
distance
32. Shines a bright light obliquely
into each pupil in turn.
G. TESTING FOR EXTRAOCULAR MUSCLES
33. Asks the patient to follow your
finger or pencil as you sweep
through the six cardinal
directions of gaze (making a
wide H in the air)
H. SUMMARY
34. Summarizes the findings to the
patient.

35. Interprets the findings to the

patient

36. Asks the patient for further

clarifications and questions

37. Thank the patient

Name and Signature of Preceptor__________________________________

Date__________

Updated and Revised by: Dr. Gladys Ogatis-Sermon

Compiled by: Dr. Claire Frances Miyake