eye examination
DESCRIPTION
opthalmologyTRANSCRIPT
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The Eye Examination
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ANATOMY
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AnatomyExtraocular movements
MedialLateralUpward Downward
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Visual Acuity General physical examination should include :Visual acuityPupillary reactionExtraocular movementDirect ophthalmoscope Dilated exam (in case of visual loss or retinal pathology)Distance or NearDistance visual acuity at age 3early detection of amblyopia
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Distance Visual Acuity TestingVA - Visual acuity OD - ocular dexterOS - ocular sinisterOU - oculus uterque
20/20 (6/6;5/5,1.0)
Distance between the patient and the eye chart _____________________________________________Distance at which the letter can be read by a person with normal acuity
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Distance Visual Acuity TestingPlace patient at 20 ft (6m) from Snellen chart OD then OSVA is line in which > letters are read Pinhole if < 20/20 or < 6/6
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Snellen eye chart Rosenbaum pocket chart
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Distance Visual Acuity TestingIf VA < 20/400 or < 6/60Reduce the distance between the pt and the chart and record the new distance (eg. 5/400)If < 5/400 (< 6/60)CF (include distance)HM (include distance)LPNLP
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Near Visual Acuity TestingUsually done when Patient complains about near visionDistance testing difficult/impossible But after check the distance we have to check the near acuity alsoDistance specified on each card (35cm)
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Anterior SegmentInspection of:EyelidsConjunctiva and scleraCorneaAnterior chamberIrisPupil lens
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Anterior chamber depth assessment
Likely shallow if 2/3 of nasal iris in shadow
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Pupillary ExaminationDirect penlight into eye while patient looking at distance
Direct Constriction of ipsilateral eyeConsensual Constriction of contralateral eye
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Ocular Motility
Rt superior rectusLt inferior oblique Lt superior rectusRt inferior obliqueRt lateral rectusLt medial rectusLt lateral rectusRt medial rectusRt inferior rectusLt superior oblique Lt inferior rectusRt superior oblique
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Direct Ophthalmoscopy Tropicamide or phenylephrine for dilationunless shallow anterior chamberunless under neurological evaluationUse own OD to examine OD with Right hand to hold the ophthalmoscopeSame for OS
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Posterior SegmentDirect Ophthalmoscopy
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Evaluated:Papil Nervus Opticus Blood Vessel of Retina (arteri vein ratio, bleeding, vena microaneurysm)Retina (subhyaloid bleeding, dot blot, flame shape, oedem macula)
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Intraocular Pressure Measurement
Range: 10 22Gold standard: Goldmann Aplanation tonometryMore simple device for GP:Digital palpation of IOPSchiotz tonometry
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Schiotz toometryAplanation tonometryNon Contact tonometry
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Schiotz Tonometry callibaration
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Summary of steps in eye examVisual AcuityVisual fields ( confrontation )Extraocular movementsInspection of anterior Segmentlid and surrounding tissue, conjunctiva and sclera,cornea, anterior chamber, iris, Pupillary examination, Lens clarityTonometry (Schiotz, Digital palp)Fundus examinationFundus reflex, Optic Nerve (Cup &Disc ratio, margin, color), vitreous, vessels and macula
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