CLINICAL SKILLS OF EYE

EXAMINATION

• BY DR. HAJER AHMED

1. TAKING AN OPHTHALMIC HISTORY.

2. ASSESSMENT OF VISION.

3. EXTERNAL EXAMINATION.

4. ANTERIOR SEGMENT EXAMINATION.

5. EXTRAOCULAR MOTILITY AND ALIGNMENT.

6. CONFRONTATION VISUAL FIELDS.

7. INTRAOCULAR PRESSURE.

8. FUNDOSCOPIC EXAMINATION.
 TAKING AN OPHTHALMIC HISTORY
➢ PRESENTING COMPLAIN

➢ HISTORY OF PRESENTING COMPLAIN

➢ PAST OPHLTALMIC HISTORY

➢ PAST MEDICAL HISTORY

➢ FAMILY HISTORY

➢ SOCIAL HISTORY

➢ DRUGS AND ALLERGIES

 ASSESSMENT OF VISION

I. Visual acuity.

II. Colour vision.

III.Contrast sensitivity.
 I. Visual acuity
According to: 1.Age 2.Language 3.Literacy

Types of VA.: 1. Distance V.acuity 2. Near V.acuity

• Unaided
• Aided(with prescription ’’ by personal glasses or lenses of trial box’’)
• Pinhol(correct about 3d)

1. Distance V. acuity (far vision 6meter):

▪ ADULT :1.Snellen chart 2. Landolt c chart 3.Illiterate e chart
4.Log mar
➢ 6/60, 6/36, 6/24, 6/18, 6/12, 6/9, 6/6
➢ CF, HM, PL(good or bad projection).
Snellen chart

Log MAR chart

 Trial box

pinhole
▪ Children:

❑ >3yrs: *kay picture test *log mar *snellen chart

❑ <2yrs: *kay picture test *cardiff cards

❑ Infant : *Prefrential looking test: keller ,…..

*Clinical tests: fixing and following(CSM), objection to
occlusion, picking up fine objects

*Electrodiagnostic test: VEP(visual evoked potential).

2. Near V.acuity (near vision): good illumination, at 30-40cm
• “Central, steady, maintain (CSM)” approach. Central: is the corneal
light reflex in the center of the pupil? Steady: can the patient
continue fixating when the light is slowly moved around? Maintain: can
the patient maintain fixation with the viewing eye when the previously
covered eye is uncovered?
II.Colour vision

➢ ISHIHARA plates, in good illumination, 2/3m.

III.Contrast sensitivity
 EXTERNAL EXAMINATION:
• Habits
• Head position: (note it during va. Assesment)
1. Heat tilt 2. Face turned 3.Chin elevation or depression .
• Brow symmetry
• Periorbital lesions(masses, injuries, ecchymosis)
• Globe position(proptosis, enophthalmos,dystopia).
• Ptosis,lid retraction
• Palpate: 1.Bony orbital margin 2.Lacrimal gland 3.Globe(any
pain,pulsation)
• Test for orbicularis ms. Function.(Intact bell’s phenomena)
 ANTERIOR SEGMENT
EXAMINATION
❑Eyelid:
• Masses(sty, Chalazion, Molluscum, Epidermoid Cyst…)
• Swelling(allergy, Abscess, Infection, Trauma)
• Xanthelasma
• Dermatochalasis: redundant eyelid skin.
• Blepharochalesis: protrusion of orbital fat through
orbital septum.
❑ Lashes:
• Loss : Madarosis (patchy or diffuse loss of eyelashes)
• Colour: Poliosis(white Lashes)
• Direction: > Lashes Misdirection(<4 Lashes).
> Trichiasis(>4 Lashes).
• Crusting: ex.Blepharitis
• Distichiasis: extra row of eyelashes.
• Hyper trichchosis:
a) Trichomegaly→abnormal long.
b) Polytichosisi→ excess number.
• Lid margin: 1>position:
o Entropion→ rolling inward of lid margin toward the globe.
o Ectropion→ rolling outward of lid margin from the globe.

2>Skin folds:
o Epicanthus→accessory fold of skin extending from the nose to the
inner end of the eyebrow.

3>Defects: coloboma , after trouma.

4>Inflammation: bepharitis, any discharge,
redness.
5>Blocked meibomian glands.
• Lacrimal system:
• >Epiphora
>Puncta: position on glob,
swelling, stenosis, FB
>NLD swelling (acute or chronic)
>Regaurge test
• Conjunctiva: WHITE AND QUIET?
➢Palpebral: papillae,
follicles,scar, Concretion,
discharge, membranes or
pseudomembrane.
 ➢Fornices: loss(symblepharon , ankyloplepharon)

➢Bulbar: hyperemia, hge, lumps, degenerations, fbs.

Episcleral & sclera: White and quiet?
➢Nodule, redness, thinning, discoloration(blue sclera,
necrosis),perforation.
• Cornea:
➢Diameter
➢Transparency
➢Fb
➢Lacerations or ulcers
➢Degnerations
➢Vascularity
➢Sensation
Anterior chamber:
Depth(normal,shallow ,deep)
Content(IOL, Hyphema, Hypopyon, Granuloma, Flar &cells)
• Iris:
➢ Colour(in same eye &btw two eyes)
➢ Pattern
➢ Defects(iridotomy, iridectomy,
iridodialysis,coloboma,tear,atrophy)
➢ Synechia(complete or partial).
➢ Polycoria>more than 1 pupil
➢ Corectopia>not central pupil
•
 Polycoria
correctopia
Pupil:
➢ Colour(black, greyish blacke,greyish
white,jet black,white)
➢ Central
➢ Round
➢ Regular
➢ React( to light and near)
➢ Any anisocoria(unequal pupil size
btw two eyes)’’test in dark & will-
illuminated condition
Lens:
➢Pigmentation
➢Immature cataract
➢Mature cataract
➢Pseudophakia
➢Apkakia
 Types of pupil reactions
1. Direct light reflex : 3Ds.(Dim light , patient looking for
Distance, Don’t stande infront of patient)will (constrect
same testing eye)

2. Indirect light reflex(consensual): (constrect non testing

eye)

3. Swinging light reflex(if any RAPR)

4. Near reflex(constrict pupil ,accomodation ,converge)
 EXTRAOCULAR MOTILITY AND
ALIGNMENT
• Chek corneal light reflex(Hirchberg test) if central in both pupil.

• Have the patient look in the six cardinal positions of gaze. Test
with both eyes open to assess versions — repeat monocularly to
test ductions.
 CONFRONTATION VISUAL FIELDS
• Assess central field by asking tha patient to concentrate on
your nose and if there is any missing parts from your face
• Assess each quadrant monocularly by having the patient count
the number of fingers that you hold up. If acuity is particularly
poor, have the patient note the presence of a light.
• Use the colored lid of an eyedrop bottle to define the position
of a scotoma more accurately.