Physical Exam of the Eye

1.

Inspection

Eyes & orbits (size, shape,

symmetry, scars, swelling)

Loss of lateral 1/3 eyebrows

(hypothyroidism, leprosy,
myxedema)

Absent reflection at nasal

field of eye (extra ocular
muscle dysfunction)

Eyelids (position, swelling,

redness, lesions)

Conjunctiva (pallor,
hemorrhage, swelling,
inflammation, growths)

Lacrimal apparatus
(Sjogrens syndrome,
dacryocystitis, epiphora)

2. Pupils

3.

4.
Check direct &
consensual
response to light

Miosis

Mydriasis

Anisocoria
Check
accommodation
reflex
Check reflection
(cataract, Rb)

Extra ocular motility

H test: Have the pt

look at the 6
positions of gaze.
Test both eyes at
once to assess
versions and then
single eye at a
time Cover/uncover
test: assess for
heteropias

Intraocular pressure

If ruptured globe is
suspected, avoid
this test

Tonometry is
employed

5.

6.

Visual fields:

Temporal field : ask

pt to indicate when
he sees your
fingers appear
from beyond the
lateral margins of
orbits in horizontal
plane , & upper &
lower quadrants

Nasal field: cover

one of your eyes &
ask pt to do the
same. Repeat test

Visual acuity

Position pt about 20
feet from Snellens
chart. Test both eyes
separately with one
eye covered then
both eyes at once.

Myopia (near
sightedness)

Hyperopia
(far
sightedness)

Presbyopia

Astigmatism

7.

8.

Fundoscopy

Absent red reflex

(cataracts, corneal
scarring, Rb)

Drusen

Coloboma

Glaucoma

Hypertensive
retinopathy

Papilledema

Diabetic
retinopathy

Slit-lamp examination

Lids/lashes/lacrimal
system (anatomy,
contours)

Conjunctiva/sclera (color,
injection, lesions)

Cornea (clarity, epithelial

disruptions, stromal
opacities, endothelial
lesions)

Anterior chamber (deep,

cell or flare)

Iris (round pupil,

transillumination defects,
nodules)

Lens (clarity, nuclear,

cortical or subscapular
cataract)

Anterior vitreous