UNIVERSITY OF SANTO TOMAS

Faculty of Medicine & Surgery

EYES
Prepare materials: penlight, pocket held card, ophthalmoscope.
Give proper instruction to patient
Ask patient to be seated at a height such that their eyes are essentially on the same level as the examiner own when the
latter is seating/standing next to the patient
Assessment of visual acuity (Central Vision)
Position patient 20 feet from Snellen chart and ask patient to read OR ask patient to hold pocket card 14 inches away and
read
Test one eye at a time initially without correction (sc) then with correction (cc) while covering the other eye with an occluder
shield or any opaque card
Ask patient to read each line from the largest print down to the smaller characters
Choose the lowest line where majority of the letters are read accurately and record visual acuity as a fraction
Repeat the steps for the other eye
Interpret the results
Perform the following in cases of patient’s failure to read the largest letter at 20 feet:
- Bring patient closer to chart ( to 10 feet, then 2 feet at a time, until the top letter can be seen
- Counting fingers (CF) if the patient cannot read at 5/200
- Hand movements (HM) if the patient cannot count fingers
- Light perception (LP) if the patient cannot see hand movements
Assessment of visual acuity (Peripheral Vision) - Visual Fields by Confrontation Method (Static)
Sit or stand opposite the patient at eye level at a distance of 1 meter or 2 feet and
instructs patient to cover right eye with card or an occlude shield while examiner covers his/her left eye, the patient and
examiner should be looking at each other’s eye
Examiner should fully extend his/her arm midway between patient and himself/herself and then moves arm slowly centrally.
Examiner asks patient to point at fingers once seen
Examiner holds up a few fingers in that position and instructs patient to say how many fingers are seen
Repeat steps in all four quadrants (nasal superior, nasal inferior, temporal superior, temporal inferior)
Repeat steps for other eye.
Report and interpret findings
Observation of External Structures:
Inspect eyebrows for loss/extraordinary growth of hair; presence of seborrhea. Inspect eyelashes for any matting or loss.
Inspect eyelids for symmetry and presence of crusting, redness, swelling
Instruct patient to look up. Pull down lower lid of each eye to expose inferior sclera and conjunctiva. Using a penlight,
inspect sclera and conjunctiva of lower eyeball for color, swelling and vascularity.
Instruct patient to look down. Examiner pulls up upper lid of each eye to expose superior sclera and conjunctiva. Using a
penlight, inspect sclera & conjunctiva of upper eyeball for color, vascularity, and swelling
Recognize conjunctival presentation, report and interpret findings.
Inspect orbits and eyes for position, alignment, symmetry, size, and shape. Standing behind the patient, look for proptosis
by instructing the patient to tilt back head. Examine the height of the cornea in relation to the brow for asymmetry between
two eyes.
Inspect cornea with oblique and direct lighting, and note for any opacities visible in the pupil.
Inspect size, shape, markings, definition, and color of the iris.
Testing Extra-Ocular Movements
Instruct the patient to follow examiner’s index finger with their eyes only i.e. their head remains in one position)
Move finger slowly to extreme position of each of the six (6) cardinal positions of gaze. The path may trace out the letter H.
Observe for under or over action of the extraocular muscles
Inspecs for normal or abnormal movements in each position.
Report and interpret findings
Pupillary Testing
Dim the lights in room
Instruct patient to look into distance and not to focus on the light.
Illuminate both eyes with oblique lighting to discern pupil size and shape.
Shine bright light into each pupil from a point slightly lateral to the patient’s line of vision
Check for pupillary constriction in the eye that light is shined into (direct reaction).
Note the consensual response of the opposite pupil constricting simultaneously with the tested pupil. Repeat steps for the
other eye.
Perform the swinging flashlight test and reports findings
Hold your index finger approximately 2 feet from the patient’s eyes
Instruct patient to focus on the index finger as you move it towards the patient’s nose.Note for pupillary constriction as the
finger moves closer(accommodation) and crossing of the eyes(convergence)
Evaluate pupillary response to accommodation in each eye.

EYE 2016-2017
 UNIVERSITY OF SANTO TOMAS
Faculty of Medicine & Surgery
Department of Medicine
Medicine 1
Eye Examination Checklist

Ophthalmoscopic Examination
Darken the room.
Instruct patient to fix eyes on a specific point in the distance and try not to move eyes correct setting.
Hold the ophthalmoscope with your right hand when examining the patient’s right eye and use the ophthalmoscope with
your left hand when examining the patient’s left eye.
Turn on the light source of the ophthalmoscope. Turn the aperture wheel to the spot that is generally used for undilated
fundus examination. Set ophthalmoscope at 0. Use ophthalmoscope with ease and dexterity.
Position yourself at arm’s length from the patient. When examining the right eye of the patient, place your left hand on the
patient’s forehead with the left over the patient’s right eyebrow to assist stability. Alternatively, place your left hand on the
patient’s shoulder for stability.
From an angle of about 15 to 20 degrees lateral to the patient’s line of vision, shine the ophthalmoscope towards the pupil
of the right eye and look through the ophthalmoscope’s viewing hole.
Note for orange glow in pupil, the red reflex, and check for opacities blocking the red reflex.
Move closer to patient’s eye while slowly rotating the adjustment wheel of the ophthalmoscope using the index finger up or
down until the structures become clear. Turn the diopter disc counterclockwise for convex (plus) lenses, which are printed in
black, or turn the diopter disc clockwise for concave(minus) lenses, which are printed in red, until the sharpest focus is
achieved
Examine retina, optic disc, retinal vessels, peripheral retina and macular area.
Repeat steps for left eye
Describes disc margin, reports cup/disk ratio, A:V ratio , absence/presence of hemorrhages, exudates, cotton wool
spots, copper wiring, AV nicking
Report and interpret findings

EYE 2016-2017