SHORT CASE

EXAMINATION OF EYE
Inspection

• Observe periorbital region, eyelids and eyes

1. Signs swelling, redness, discharge, trauma, scar, cork screw

Cork screw appearance
2. Pupillary size, symmetry – size 2-8 (2-4 normal)
3. Proptosis – more than 2cm from lateral orbital rim to corneal apex (ruler’s test)
Inspection
• Observe periorbital region, eyelids and eyes
4. Ptosis – Marginal reflex distance (distance from corneal light reflex to
the margin of the upper lid)
5. Signs of horner syndrome – miosis, anhyidrosis, partial ptosis
The difference in MRD 1
between two eyes:

•2mm – Mild ptosis

•3mm – Moderate ptosis
•4mm – Severe ptosis 
Palpation

1.Condition of skin -hydration , i.e dry – horner sy.

• Thrill
Auscultation

• Auscultation at 5 point – eyelid, frontal , malar,

temporal, mastoid (use bell’s on eyelid ,and
diaphragm on other point)
 Pretectal nuclei

Examination :CN II
Lateral Geniculate Body
4. Direct and indirect Pupillary reflex (dim Edinger
the lights) Westphal
Nucleus
5. Swinging Light test:
RAPD – relative AFFERENT pupillary defect
:paradoxical dilatation of the affected
pupil when the light is shone on it
positive RAPD means there are differences between the two
eyes in the afferent pathway due to retinal or optic nerve
disease.
Examination : CN II

1. Visual Acuity (Snellen’s chart), Colour

2. Confrontation test: visual field, using white pin (red pin for blind
spot)
3. Fundoscopic examination (dim the lights):
short narration: 10-15’ toward nasal. Red reflex. Assess according to quadrant;
Vessels, optic disc, macula (midline) . Grading – modified Frisen.
Examination :CN III, IV, VI
1. Extraocular eye movement – H test , observe nystagmus,
2. CN 4 – intorsion, adduction and depression (observe presence of head tilt) :
3. Accommodation reflex : ask patient to focus on distant object, place your finger
in front of their eyes (20-30cm) then switch from the distant object to the finger.
Observe the pupil -should see the constriction and convergence (retraction of
eyeballs) bilaterally
 Other examination
• CN V, VII : corneal reflex (afferent and efferent)
• CN VII : orbicularis oculi

For saccades – don’t put at extreme end (like this

picture), instead, 1 object at right, another end at
centre (to test the right eye’s saccade), vice versa
for left side and for horizontal saccade.
Credit to Dr Zhafran, Dr Murni