CLINICAL METHODS

IN
OPHTHALMOLOGY
BY
Dr. FERIYANI.SP.M

HISTORY TAKING
Profesional history helps some times in
estabilished the diagnosis
The common Ocular complaints include
Defective Vision
Watering and/or Discharge
Redness
Photophobia
Itching


a.

Defective Vision
Sudden Painless loss of vision
Retinal Detachment
Central Retinal Artery Occlusion
Vitreous Haemorrhage
Central Retinal Vein Occlusion
Spontaneous Dislocation of Lens
Central Serous Retinopathy
Optic Neuritis

b. Sudden Painful Loss of Vision

Acute Attack of Primary Narrow Angle
Glaucoma
Attack of Secondary Congestive Glaucoma
Acute Iridocyclitis
Injuries to the Eyeball which maybe
Mechanical
Chemical or Thermal in Nature

c. Gradual Painless Loss of Vision

- Senile Cataract
- Refractive Errors
- Corneal Degeneration
- Chorioretinal Degeneration
- Age Related
Macular Degeneration
- Optic Atrophy
d. Gradual Painfull Los Of Vision
- Chronic Iridocyclitis
- Chronic Glaucoma

e. Night Blindness ( Nictalopia )

- Vit. A Deficiency
- Retinitis Pigmentosa
- Pathological High Myopia
- Peripheral Lenticular Opacities
- Peripheral Corneal Opacities
f. Defective Vision For Near Only
- Presbyopia
- Cycloplegia
- Internal or Total Ophthalmoplegia

Watering From The Eyes

a. Excessive Lacrimation
b. Epiphora
Discharge
- Mucoid
- Mucopurulent
- Purulent
Redness Of Eyes : Conjunctivitis, Keratitis ,
Iridocyclitis, Acute Glaucomas

General Physical and Systemic Examination

- Ankylosing Spondilitis Uveitis
- Grave Disease Exophthalmus
OCCULAR EXAMINATION AND DIAGNOSTIC TESTS
1. Testing Of Visual Acuity
Distant

Near

-SNELLENS TEST
-SIMPLE PICTURE CHART
-E- CHART
-LANDOLTS C-CHART
-JAEGERS CHART
-ROMAN TEST TYPE
-SNELLENS NEAR VISION
TEST TYPE

2. External Ocular Examination

General Inspection In Diffuse Light
Examination in focal ( or Oblique ) Illumination
Special Examinations
a.

EYE BROWS :
- Level Of The Two Eyebrow
- Cilia

b.

EYE BALLS :
1. Position
Normally, the two eyeballs are symmetrically placed in the orbits in suchs
a way that a line joining the central points of superior & inferior orbital
margins , just touches the cornea

2.
3.

Size Of Eyeball USG ( a- Scan )

Occular Movements

c. PALPEBRA APERTURE / PALPEBRA FISSURE

- Horizontally: 28-30 mm
- vertically : 8-10 mm
- Abnormalities : - Ankyloblepharon
- Blepharophymosis

THE EYELIDS
POSITION

NORMALLY : The lower lid just touches the

limbus while the upperlid covers
about 1/6 th ( 2mm ) of cornea

ABNORMALLITIES :
- Ptosis : > 1/6 th of cornea
- Thyrotoxicosis : Lid retraction

 MOVEMENTS

NORMALLY : The upper lid follows the

eyeball in down ward movement

BLINKING : Normal rate 12-16 blinks/minute

LAGOPHTHALMUS :
- Facid nerve palsy
- Extreme degree of proptosis
- Symblepharon

LID MARGIN

Enteropion
Ectropion
Trichiasis
Madarosis
Poliosis
Swelling

CONJUNCTIVAL

Discoloration
Congestion of vessel : inj.Cilliaris, inj. Conjunctiva
Conjunctival Chemosis
Folli cless
Papillae
Foreign bodies
Pingueculae
Pterygium
Conjunctival cyst
Conjunctival tumors

SCLERA
-

Discoloration
Inflammation
Traumatic Perforation

CORNEA
- Loupe
- Slit Lamp biomicroscope
-

Size
- Microcornea < 10mm micropthalmus
- <<< Ptisis bulbi
- Megalo cornea > 13 mm bupthalmus

SHAPE ( CURVATURE )

- KERATOGLOBUS
- KERATOCONUS
- CORNEA PLANA

SURFACE
TRANSPARANCY
CORNEAL SENSATIONS

ANTERIOR CHAMBER SLIT LAMP

a.

Depth: - normal 2,5 mm

- shallow : - hipermetropia
- anterior sub luxation of lens
- deep: - aphakia
- buphthalmus
- keratoconus

b.

Contents ; - blood hyphema

- pus hypopion
- Flare
IRIS
COLOR Varies in different cases

PUPIL : Number , location, size