EXAMINATION OF EYE

EXAMINATION OF EYE
An examination of the eye includes an external exami
nation:-
 Examination by ophthalmoscope, and
 An assessment of the functions of eye
CONTI...
 A. EXTERNAL EXAMINATION
 B. PUPILLARY RESPONSE
 C. FUNCTIONAL EXAMINATION
A. EXTERNAL EXAMINATION
 It consist of inspection of the eyelids, surrounding tiss
ue and palpebral fissure.
 Palpation of the orbital rim may also be desirable, dep
ending on the presenting signs and symptoms
The conjunctiva and sclera can be inspected by having
the individual look up, and shining a light while retrac
ting the upper or lower eyelid
CONTI...
The cornea and iris may be similarly inspected.
 The anterior segment of the eye examined by visual inspection.
 Note the general appearance of the eyelids, eyelashes and lacri
mal apparatus.
Observe for:-
 1. Redness around the eye
2. Discharge or crusting
3. Growths on eyes or eyelids
4. Excessive tearing
 Position and mobility can be observed by having the patient ro
tate the yes, looking up, down and each side.
B. PUPILLARY RESPONSE
 Normal pupils are rounded, centrally placed and generall
y equal in size (about 25 percent of normal individuals hav
e pupils slightly unequal in size.)
REACTION TO LIGHT:- Seat the patient in an area with
even lighting and instruct him to fix his gaze on the distan
t object.
 Cover one eye and shine a flashlight in front of the expose
d eye. The pupil should (constrict) because of the light. T
his response is called a direct reaction.
 The covered pupil should also contract. This response is c
alled a consensual reaction.
NEAR POINT REACTION:-
When the gaze is changed from the distant object to a
n object close at hand, the pupils should contract
C. FUNCTIONAL EXAMINATION
1. Focusing power is tested by placing a line of print cl
ose to the eye, then slowly moving it back to the point
at which the patient is able to read it. The nearest poin
t of accommodation.
CONTI..
 Colour sense is tested by using specially designed colo
ur pates to distinguish reds, greens and blues. 10/19/20
18
 Visual acuity testing is done with Snellen chart or on
e of its modifications. Each eye is tested separately, bot
h with and without glasses, if worn.
ASSESSING SYMPTOMS
In addition to the examinations mentioned previously,
the patient should be assessed:-
 Discomfort or pain in or around the eye
 Photophobia (abnormal sensitivity to light)
 Nystagmus (involuntary and rapid movement of eyebal
l.)
 Strabismus (deviation of eye from the normal physiolo
gical axis: ‘crossed vision’)
 Blurred vision
 ‘Spot 'or ‘light 'in the visual field
EYE TESTS AND EXAMS OPHTHALMOSCOP
Y:-
 It is an examination of the back part of the eyeball (fu
ndus), which includes the retina, optic disc, choroid a
nd blood vessels. Ophthalmoscope examination takes
about 5 and 10 minutes. There are different types of op
hthalmoscopy.
THERE ARE TWO TYPES:-
DIRECT OPHTHALMOSCOPY
 Patient will be seated in a darkened room. The health
care provider performs this common exam by shining
a beam of light through the pupil using an instrument
called an ophthalmoscope.
 It allows the examiner to view the back of eyeball.
CONTI…
INDIRECT OPHTHALMOSCOPY
 Patient will lie or sit in a semi reclined position. The h
ealth care provider holds patient eye open while shinin
g a very bright light into the eye using an instrument w
orn on the head.
 Some pressure may be applied to the eyeball using a s
mall, blunt tool. Patient will be asked to look in variou
s direction
APPLANATION METHOD
 This eye test helps doctors to diagnose glaucoma by m
easuring the amount of pressure needed to flattern a p
ortion of the cornea.
 This is done by taking a thin strip of paper
CORNEAL TOPOGRAPHY
 Corneal topography is a computer assisted diagnostic too
l that creates a three-dimensional map of the surface curv
ature of the cornea.
 The cornea (the front window of the eye) is responsible f
or about 70 percent of the eye’s focusing power. An eye wi
th normal vision has an evenly rounded cornea, but if the
cornea is too flat, too steep, or unevenly curved, less than
perfect vision results.
 The greatest advantage of corneal topography is its abilit
y to detect irregular conditions invisible to most conventi
onal testing
CONTI.....
This is an eye test used to evaluate the blood circulation in
the retina. It is useful in helping diagnose diabetic retinop
athy and retinal detachment.
 During this eye test, a special dye called fluorescein, is inj
ected into a vein in the arm and it quickly travels to blood
vessels inside the eye.
 When it reach to the eye a specialized camera is used to t
he photograph the fluorescein as it circulates through the
blood vessels in the back of the eye.
 This will enable the doctor to diagnose any circulation pr
oblems, swelling, leaking or abnormal blood vessels
PUPILLARY DILATION TEST
During this eye test, the eye doctor places special drop
s (Tropicamide) in the eye that cause the pupil to dilat
e. By dilating the pupils, doctor can examine retina for
any signs of disease.
REFRACTION TEST
 This is measures the ability to see objects at special di
stances. Often doctors will ask the patient to look at a
chart usually 20 feet away and try to read it while looki
ng through a special; instrument know n as a phoropte
r.
 The eye test is useful in helping to diagnose presbyopi
a (long-sightedness ), hyperopia (nearby objects are bl
urry), myopia (lose objects appear clearly, but far ones
don't.) and astigmatism (eye does not focus light evenl
y).
FLUORESCEIN ANGOGRAPHY
Fluorescein angiography, fluorescent angiography, or f
undus fluorescein angiography is a technique for exam
ining the circulation of the retina and choroid using a
fluorescent dye and a specialized camera.
COLOR FUNDUS PHOTOGRAPHY
 Fundus camera to record color images of the conditio
n of the interior surface of the eye, in order to docume
nt the presence of disorders and monitor their change
over time.
 A fundus camera or retinal camera is a specialized low
power microscope with an attached camera designed t
o photograph the interior surface of the eye, including
the retina, retinal vasculature, optic disc, macula, and
posterior pole (i.e. the fundus).
CONTI....
The retina is imaged to document conditions such as d
iabetic retinopathy, age related macular degeneration,
macular edema and retinal detachment.
SLIT- LAMP EXAM
 Once patient in the examination chair, the doctor will
place an instrument in front of patient on which to rest
chin and forehead.
 This helps steady head for the exam. Doctor may put
drops in eyes to make any abnormalities on the surface
of cornea more visible.
 The drops contain a yellow dye called fluorescein, whi
ch will wash away the tears. Additional drops may also
be put in eyes to allow pupils to dilate, or get bigger
CONTI....
The doctor will use a low-powered microscope, alon
g with a slit lamp, which is a high-intensity light. Th
ey will look closely at eyes. The slit lamp has differen
t filters to get different views of the eyes. Some docto
r’s offices may have devices that capture digital imag
es to track changes in the eyes over time.
During the test, the doctor will examine all areas of
your eye, including the:- eyelids, conjunctiva, iris, le
ns, sclera, cornea, retina and optic nerve
TONOMETERY
 Tonometry is the procedure eye care professionals per
form to determine the intraocular pressure, the fluid p
ressure inside the eye.
It is an important test in the evaluation of patients at r
isk from glaucoma.
 (normal pressure range is 12 to 22 mm Hg)
CONTI....
Before the tonometry test, eye doctor will put numbin
g eye drops in eyes so that patient don’t feel anything t
ouching them.
 Once eye is numb, doctor may touch a tiny, thin strip
of paper that contains orange dye to the surface of eye t
o stain it. This helps increase the accuracy of the test
CONTI....
Doctor will then put a machine called a "slit- lamp" in
front of patient. Patient will rest chin and forehead on
the supports provided.
 The lamp will then be moved toward eyes until just th
e tip of the tonometer probe touches cornea. By flatten
ing cornea just a bit, the instrument can detect the pre
ssure in eye. Doctor will adjust the tension until they g
et a proper reading.
CONTI....
Because eyes are numb, patient will feel no pain durin
g the procedure. Tonometry is extremely safe. However
, there’s a very minimal risk that cornea could be scratc
hed when the tonometer touches eye.
 Even if this happens, however, it will normally heal its
elf within a few days
ULTRASOUND BIOMICROSCOPY
 Ultrasound bio microscopy is a type of ultrasound eye
exam that makes a more detailed image than regular u
ltrasound.
High-energy sound waves are bounced off the inside o
f the eye and the echo patterns are shown on the scree
n of an ultrasound machine
ELECTRORETINOGRAPHY
 Electroretinography measures the electrical responses
of various cell types in the retina, including the photor
eceptors, inner retinal cells, and the ganglion cells.
OTHER TEST
 VISUAL ACUITY TEST (SNELLEN CHART)
THANK YOU