Increasing

Ocular Awareness

Ophthalmology Department
Brawijaya University / Saiful Anwar General Hospital
Malang
2017
1. Recognizing ocular emergency
2. Recognizing systemic-related ocular conditions
3. Performing simple visual acuity assesment
4. Performing appropriate pupils examination

Purpose
 • Sight-threatening conditions
• Sudden visual loss

Isolated Systemic-related

• Rhegmatogenous RD
- Central retinal artery occlusion
• Acute angle closure glaucoma
- Ischemic optic neuropathy GCA
• Severe corneal ulcer
• Chemical injury
Open globe injury

Ocular emergency
Systemic-related ocular
conditions
 Lagophthalmos

Chemotic Exposure
keratitis

Decrease of conciousness
 CORNEAL
ULCER

Decrease of conciousness PERFORATION

Diabetic patients
Hypertensive patients
Increased ICP
VISUAL ACUITY
EXAMINATION
Snellen chart
 Visual Acuity

The ability of patient’s eye see to the subject at the certain size and distance

compared with

The ability of the person with the normal vision see that subject

5/5…………the patient can see the subject at 5 m

the person with normal vision can see the subject at 5 m

5/20……….. the patient can see the subject at 5 m

the person with the normal vision can see the subject at 20 m
The distance can be adjusted,
depend on the Chart’s type
Check each eyes alternately
Start with the right eye  close the left eye
with patient’s palm / occluder
 WHAT TO DO IF PATIENT CAN’T READ
THE BIGGEST LETTER OF THE SNELLEN CHART ???
If the patient can’t read the biggest letter

Finger counting test

Can’t see the finger at 1 m

Hand motion test

Can’t see the motion

Light perception test

FINGER COUNTING TEST

Start from 5 m then step

forward every 1 m

If the patient see the finger

at 1 m………. 1/60

2 m ……… 2/60
Hand Motion Test

If the patient can see the motion  VA is 1/300

 Light Perception Test

If the patient can see the light, the visual acuity is 1/~ or LP (+)
Ask the patient about the direction of light
LP (+)  check projection of illumination
If the patient can’t see the light  LP (-) or 0

Total blindness
Visual examination in
specific conditions
On the bed  Finger counting

Max : 2 m  > 2/60 (sitting)

On the bed  Finger counting

Max : 1 m  >1/60 (lying down)

Uncooperative patient/baby – young children

 Light fixation  infants

 Object fixation  older

Do not use noisy toys to assess VA

PUPILLARY EXAMINATION
 1. SIZE: N  2-6 mm, normal light 3-4 mm
2. SHAPE : round, regular
3. EQUALITY : iso/anisocoria.
Anisocoria  difference  2 mm
4. POSITION : Centre within the iris
5. LIGHT REFLEX

PERRLA (Pupils equal, round, reactive to light and accomodation)

No need to check near response if light reflex is normal 27
VARIATIONS OF NORMAL PUPILS
• Varies with age, sex, intensity of light, different
levels of illumination
• Pupillary reaction does not develop until 31 wks of
gestational age
• Larger in:
- Adolescent and midde-age pts
- Women
- Myopes
- Blue irides
28
 LIGHT REFLEX EXAMINATION

Clinical pearls:
• Check each eye alternately
• Ask patient to look at a distance object
• Use penlight with milimeter ruler
• Do not shine the light source directly into the
patient’s eye
• Perform under dim illumination  switch off the
lamp if necessary
29
1. Observe the direct response (constriction of
the illuminated eye)

2. Observe the consensual response (constriction

of the opposite pupil)

3. Repeat with the opposite pupil

30
Do not ever forget!

1. To see clearly the pupil reaction to light, the patient

should be instructed to look at a distant object to
reduce accomodation
2. By standing in front of the patient, the doctor
stimulates accomodation and hence miosis
3. Miosis occurs with accomodation