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  • Examination Under Anesthesia

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    Muhammad Javed Gaba
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    This document contains an examination under anesthesia template that collects patient information and records examination findings for the eyes including tests of the eyelids, cornea, anterior chamber, lens, vitreous, retina, as well as measurements of intraocular pressure and biometry readings to determine a diagnosis and treatment plan. Sections are included to document the initial exam, follow up exam, examination details for each eye, gonioscopy findings, posterior segment exam, diagnosis, procedure performed, follow up plan and date.

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    EXAMINATION UNDER ANESTHESIA

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    This document contains an examination under anesthesia template that collects patient information and records examination findings for the eyes including tests of the eyelids, cornea, anterior chamber, lens, vitreous, retina, as well as measurements of intraocular pressure and biometry readings to determine a diagnosis and treatment plan. Sections are included to document the initial exam, follow up exam, examination details for each eye, gonioscopy findings, posterior segment exam, diagnosis, procedure performed, follow up plan and date.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    13 views1 page

    Examination Under Anesthesia

    Uploaded by

    Muhammad Javed Gaba
    This document contains an examination under anesthesia template that collects patient information and records examination findings for the eyes including tests of the eyelids, cornea, anterior chamber, lens, vitreous, retina, as well as measurements of intraocular pressure and biometry readings to determine a diagnosis and treatment plan. Sections are included to document the initial exam, follow up exam, examination details for each eye, gonioscopy findings, posterior segment exam, diagnosis, procedure performed, follow up plan and date.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    EXAMINATION

    UNDER ANESTHESIA
    PATIENT PROFILE:

    Name: S/O,D/O,W/O: Age/Gender:

    Occupation: MRN: Phone no:

    Date: Address:

    Initial Exam: Date of Last Exam: Follow up Exam:

    DIAGNOSIS/PROVISIONAL DIAGNOSIS:

    EXAMINATION:

    OD OS
    DIGITAL TONOMETRY
    REGURGITATION TEST
    PUPILLARY LIGHT TEST
    Direct
    Consensual
    Swinging flash light test
    LIDS
    LASHES
    SCLERA

    CONJUNCTIVA

    CORNEA

    CORNEAL DIAMETER
    IRIS


    ANTERIOR CHAMBER


    LENS

    VITREOUS

    IOP BY APPLANATION
    RETINOSCOPY: BIOMETRY:


    SPHERE CYL AXIS
    OD OS
    OD
    K1
    OS
    K2

    AXIAL LENGTH
    GONIOSCOPY: IOL POWER

    DIAGNOSIS:
    POSTERIOR SEGMENT EXAM: PROCEDURE DONE:
    PLAN:

    FOLLOW UP DATE:

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