Eye Examination

dr. Liesa Zulhidya, Sp.M

 RSUD Dr. Soedarso

 FK Universitas Tanjungpura
 Step by Step
 Visual acuity
 Anterior segment examination (penlight)
 Ocular motility examination
 Pupil examination (RAPD) (penlight)
 Fundus reflex (direct ophthalmoscope)
 Fundus examination (direct ophthalmoscope)
 Visual field examination (confrontation)
 Intraocular pressure measurement (Schiotz
tonometer)
 Visual Acuity
 Factors (patients)
 intelligence,
 background knowledge,
 experience
 Visual Acuity

 VA 6/6 : object can be seen from 6 m that should be seen

from 6 m
 VA 6/30 : object can be seen from 6 m that should be seen
from 30 m
 VA 1/60 : counting fingers in 1 m
 VA 1/300 (HM) : hand movement in 1 m
 Visus 1/~(LP) : Light perception (projection from supeior,
temporal, inferior and nasal)
 What is blindness?

WHO classification of visual impairment

Criteria Snellen
Normal 6/6 to 6/18
Visual impairment <6/18 to 6/60
Severe visual impairment/ <6/60 to 3/60
low vision
Blind < 3/60
Refractive Media
Accommodation
 Visual Acuity Measurement

Projection Method

Courtesy from Prof. Muhaya

 Patients
seated at a standard distance
occluder
read the black symbols (alphabets,
numbers) on a white background.
Room
Courtesy from Prof. Muhaya darkened to provide optimum contrast
Visual Acuity Notation
0.1 - 6/60
0.2 - 6/30
0.3 - 6/20
0.4 - 6/15
0.5 - 6/12
0.6 - 6/10
0.7 - 6/8.5
0.8 - 6/7.5
0.9 - 6/6.6
1.0 - 6/6
 Refractive Error
 Ametropia
 ametropia axial
 ametropia curvature
 ametropia index
 Abnormal lens position
Myopia
 Myopia
 Classification
 Very mild :-1D
 Mild :1–3D
 Moderate :3–6D
 High : 6 – 10 D
 Very high : > 10 D
 Myopic Changes
 Clinical signs
 Myopic crescent (choroidal atrophy)
 Chorio-retinal myopia degenertion, tigroid fundus
 Periphery retinal degeneration  retinal detachment
 Staphyloma posticum
 Vitreous liquefaction (floaters)
Hypermetropia

After correction with S +

Astigmatism
Astigmatism
Placido Test
Normal Eye
Normal Eye
 Ocular Movement
 M. rectus superior (N III)
 M. rectus lateral (N VI)
 M. rectus inferior (N III)
 M. rectus medial (N III)
 M. obliqus superior (N III)
 M. obliqus inferior (N IV)
 Ocular motility problems
 Isolated or multiple cranial nerve involvement
 Decide location of pathology
 cavernous sinus
 superior orbital fissure
 orbital apex
 Ocular Movement
SR SR
OI SR - MR SR - MR
OI

LR MR MR LR

OS IR - MR IR - MR OS
IR IR
 Anterior Segments
 Eyelid
 Conjunctiva
 Episclera/sclera
 Cornea
 Anterior chamber
 Iris/pupil
 Lens
 Instruments
 Penlight
 Magnifying glass
 Clinical signs in eyelid problems

 Entropion - Ektropion
 Trichiasis - Districhiasis
 Hordeolum (stye) - Chalazion
 Cellulitis (preseptal/palpebral)
 Obstruction of the meibomian glands
 Others
 Tumors
 Trichiasis

Poliosis
 Preseptal cellulitis

Orbital cellulitis
Steven-Johnson Syndrome
Meibomian gland orifices

MGD 3/
Toothpaste-like
plaques
Posterior blepharitis
 What signs will you see in
conjunctiva?
 Discharge
 Watery : acute viral/allergic
 Mucoid : vernal conjunctivitis/dry eye
 Purulent : acute bacterial
 Mucopurulent : mild bacterial (chlamydia)
 What signs will you see in
conjunctiva?
 Conjunctival injection
 Subconjunctival haemorrhages
 Oedema/chemotic
 Scarring
 Follicles
 Papillary
 Granuloma
 Lithiasis
Conjunctiva
Bulbar conjunctiva

Forniceal

Palpebral/
tarsal conjunctiva
Follicles
Papillary reaction

Giant papil
Scarring/Cicatrix

Lithisis/concretions
 Granulomas

Pseudomembrane
Subconjunctival
haemmorhages
Conjunctival injection

Watery discharge
Pinguecula
(yellow-white deposits)

Pterygium
(triangular fibrovascular)
 Episcleral injection

Conjunctival injection

Ciliary injection/
Circumcorneal injection
Scleromalasia
Nodular scleritis
Scleritis necroticans
 Cornea
 Dystrophy

• Epitheliopathy
Infiltrate
 Ulcer • Bullae
 Cicatrix
 Perforation
 Foreign body
 Epitheliopathy

Bullae keratopathy
Corneal foreign
body
Dendritic
keratitis
Punctate epithelial
keratitis
Corneal ulcer

Corneal
neovascularization
 Active fungal corneal ulcer

Inactive fungal corneal ulcer

Stromal keratitis
Endothelitis
(Descemet fold)
 Pterygium

Fascicularis
ulcer
Fungal corneal ulcer
and impending
perforation
Corneal ulcer
with satellite lesion

Corneal perforation
with iris prolaps
Keratoplasty
Mooren ulcer with corneal perforation and iris prolaps
Corneal rupture and traumatic cataract
 Signs
 Iris
 Peripheral anterior synachiae (PAS)
 Posterior synachiae
 Iris nodules (Koeppe and Busacca)
 Anterior chamber angle
 Neovascularization
 Shallow/deep
 Lens
 Cataract (complication of the disease or the use of
corticosteroids)
Keratic precipitates/
KPs
Ground glass KPs
(old KPs)
Cells and Flare
 Corneal ulcer cum
hypopion (4 mm)

Corneal ulcer cum

hypopion (full)
Fungal keratitis with
hypopion

Severe anterior chamber

inflammation in fungal
keratitis
Full hyphema
Normal iris
(Normal eye)

Iritis
Posterior synachiae
Iris bombe
 Immature cataract Mature cataract

Hypermature cataract Morgagnian cataract

 Iris rupture

Traumatic cataract
Intraocular lens (IOL) IOL haptic
dislocation
Relative Afferent Pupillary
Defect (RAPD)
 Indicates optic nerve disease
 extensive damage to the retina
 a small macular lesion will not cause RAPD
 not caused by lesion posterior to optic nerve
Courtesy from Prof. Muhaya
 Optic nerve dysfunction
 Reduced visual acuity
 RAPD
 Central scotoma
 Red desaturation
 Depressed visual evoked potential
 Red reflex
 Clear cornea,
 anterior chamber
 lens
 vitreous humour
 flat retina
Courtesy from Prof. Muhaya
Courtesy from Prof. Muhaya
 Funduscopy
 Ophthalmoscope
 Examiner RE LE
Patient RE LE
Courtesy from Prof. Muhaya
Normal Fundus
Normal Fundus