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Anamnese and

Examinating Eye
By: Sayed Hamzah


Main complaint

Red eye, decreased visual acuity

Red eyes, good vision
Calm eyes, sudden decreased vision
Calm eye, visual acuity decreased slowly

History of present illness / first (duration, frequency, intermittency, and rapidity of

onset, location, the severity)

Eye medication used

Systemic - Disease? Surgery?

- Systemic Drugs in use

history of allergic

family history

Physical Examination

Ocular history : Chief complaint, past medical history, family history

External examination

Visual acuity

Visual Fields

Fundoscopic Examination

Ocular history

Chief complaint: duration, frequency, intermittency, and

rapidity of onset.

Past medical history: general state of health and principal

systemic illnesses.

family history is pertinent for ocular disorders, such as

strabismus, amblyopia, glaucoma, or cataracts, and retinal
problems, such as retinal detachment or macular degeneration.
Medical diseases such as diabetes may be relevant as well.

External Inspection

Inspect the lids, surrounding tissues, and palpebral fissure. Palpation of

the orbital rim and lids may be indicated, depending on the history and

Inspection of the conjunctiva and sclera is facilitated by using a penlight

and having the patient look up while the examiner retracts the lower lid
or look down while the examiner raises the upper lid.

Upper lid eversion

The patient is asked to look
down and the examiner grasps
the eyelashes of the upper lid
between the thumb and the
index finger. A cotton-tipped
applicator is used to press
gently downward over the
superior aspect of the tarsal
plate as the lid margin is pulled
upward by the lashes.

Bulbar conjunctiva

Alignment examination


Placido test

Fistel test


Anterior Chamber

Steps to assess anterior

chamber depth:


Shine a light from the

temporal side of the head
across the front of the eye
parallel to the plane of the


Look at the nasal aspect of

the iris. If two thirds or more
of the nasal iris is in shadow,
the chamber is probably
shallow and the angle

Pupillary examination

Pupil size
Observe reflection of pen light in both pupils. Is it symmetrical?
Test the papillary response to light

Direct response pupil constricts in examined eye

Consensual (Indirect) response pupil constricts in the opposite eye

Swinging Flashlight Test

A bright light is placed in front of one eye and moved quickly to the other
eye, then one or two seconds later moved quickly back to the first eye.
The pupils should remain constricted when the light is taken from one
eye quickly to the other

Visual acuity

Snellen Chart (Normal visual acuity is 5/5 (20/20)

Counting fingers

Hand movement

Light perception

Snellen Chart
If pt. wears glasses and
are not available use
pinhole testing.
If patient cannot read,
then document number
of fingers held up.
Hand motion at 2 ft.
If fails hand motion,
document light

Visual fields

Ask the pt to cover one eye

Cover your opposite eye

Ask the pt to look straight


Place one hand in the plane

between the patient and the
examiner out of your vision

Move the hand and ask the

patient when he/she can see
your hand

Confrontation test

Ocular movements
Six Cardinal Positions of Gaze

Fundoscopic Examination
Darken the room
Use R hand for pts R eye and L hand
for pts L eye
Ask pt to fix gaze on a spot on the wall
From about 15 away and about 15o
lateral look into pts eye
Observe the red reflex and then move
in closer
You may rest your opposite hand on
the pts forehead above the eye to
help guide
Move the opthalmoscope very close to
the pts eye
If you initially see blood vessels, you
can follow the blood vessels toward
the disc.
They flow like rivers toward the disc.
Diopters may need to

be adjusted to obtain a good

Once you see the disc, you should note its color and note what percent of the
physiologic cup involves the disc.

The cup-to-disc ratio should be less than 0.6.

You should note the size of the arterioles as compared to the veins. They should
be 2/3 to 4/5 the size of veins.

Next look in all 4 quadrants of the retina

Finally, look at the fovea and macula. This may be accomplished by asking the pt
to look at the light

Other examinations




Anel test

Schrimer test

Color vision


Digital palpation

Schiotz Tonometer

Anel Test

Hertel Exophthalmolmeter

Schirmer test

Color vision tests (Ishihara)

Thank You