2.eye examination

Eye Examination Eye Examination TechniqueTechnique

Dr. Menen

Eye Examination …Eye Examination …

1.1. Visual acuity examinationVisual acuity examination2.2. Alignment and motility examinationAlignment and motility examination3.3. Pupillary examinationPupillary examination4.4. Visual field examinationVisual field examination5.5. Intraocular pressure measurementIntraocular pressure measurement6.6. External examinationExternal examination7.7. BiomicroscopyBiomicroscopy8.8. OphthalmoscopyOphthalmoscopy

I. Visual Acuity I. Visual Acuity ExaminationExamination

Visual acuity:-Visual acuity:- the ability to discern fine the ability to discern fine visual detail.visual detail.

Distance visual acuity:-Distance visual acuity:-

- Snellen Chart!- Snellen Chart!

- Distance 6 meters. (approximates - Distance 6 meters. (approximates

ocular infinity)ocular infinity)

- numeric notation at the left of each - numeric notation at the left of each line ofline of

the snellen characters e.g. 6/12the snellen characters e.g. 6/12

Visual Acuity…Visual Acuity…

The The numeratornumerator= the distance at = the distance at which the test was performedwhich the test was performed

The The denominatordenominator = the distance at = the distance at which the letters could be seen by a which the letters could be seen by a person with “normal” visual acuity.person with “normal” visual acuity.

OD OD = Oculus Dexter= Oculus Dexter

OS OS = Oculus Sinister= Oculus Sinister

e.g. VOD=6/60 , VOS= 6/24e.g. VOD=6/60 , VOS= 6/24

Distance Visual AcuityDistance Visual Acuity

For those who are not able to see the For those who are not able to see the largest snellen letterlargest snellen letter

Repeating the visual acuity at shorter Repeating the visual acuity at shorter distancesdistances

Count the number of fingersCount the number of fingers Hand motionsHand motions Detect lightDetect light

Pinhole testPinhole test Admits only central rays of light, Admits only central rays of light,

which do not require refraction by which do not require refraction by the cornea and the lensthe cornea and the lens

If vision improves with PH - chances If vision improves with PH - chances are the patient has are the patient has refractive errorrefractive error

If no improvement with PH - the If no improvement with PH - the visual problem is due to a cause visual problem is due to a cause other than refractive error, so other than refractive error, so additional test is necessary.additional test is necessary.

Near Visual AcuityNear Visual Acuity

The ability to see clearly at a normal The ability to see clearly at a normal reading distancereading distance

=>Near acuity card (distance =>Near acuity card (distance equivalent)equivalent)

II. Alignment and Motility II. Alignment and Motility ExaminationExamination

Eye movement:-Eye movement:- -in six directions to test the function of -in six directions to test the function of the six extra ocular musclesthe six extra ocular muscles -may reveal weakness /paralysis or -may reveal weakness /paralysis or restriction restriction Eye Alignment:- Eye Alignment:- - corneal light reflex- corneal light reflex

III. Pupillary ExaminationIII. Pupillary Examination

=>Four procedures in pupillary =>Four procedures in pupillary evaluationevaluation

Measurement of pupil size in dim Measurement of pupil size in dim illuminationillumination

Speed of pupillary constriction to a Speed of pupillary constriction to a bright light bright light

Pupillary response to a near targetPupillary response to a near target Swinging light test (direct and Swinging light test (direct and

consensual pupillary reaction)consensual pupillary reaction)

Pupillary ExaminationPupillary Examination……

May reveal:-May reveal:-

- Iris muscle/ nerve damage- Iris muscle/ nerve damage

- optic nerve/retinal pathology- optic nerve/retinal pathology

- diseases of the visual pathway - diseases of the visual pathway and theand the

brain.brain.

IV. Visual Field IV. Visual Field ExaminationExamination

Measures the expanse of vision Measures the expanse of vision surrounding the direct line of sight surrounding the direct line of sight (peripheral vision)(peripheral vision)

Disturbances could be due to Disturbances could be due to diseases of the retina, optic nerve or diseases of the retina, optic nerve or structures of the visual pathway in structures of the visual pathway in the brain. the brain.

=> Confrontation field test=> Confrontation field test

V. Intraocular Pressure V. Intraocular Pressure MeasurementMeasurement

Tonometry, TonometerTonometry, Tonometer Principles:- - DigitalPrinciples:- - Digital

- Applanation e.g -- Applanation e.g -GoldmannGoldmann

-Tonopen-Tonopen

- Indentation e.g Schiotz- Indentation e.g Schiotz

VI. External ExaminationVI. External Examination

To provide an assessment of ocular To provide an assessment of ocular adnexa, external globe and anterior adnexa, external globe and anterior chamberchamber

PalpationPalpation Examination by flashlight !Examination by flashlight !

VII. BiomicroscopyVII. Biomicroscopy

Slit lamp biomicroscope!!Slit lamp biomicroscope!! A magnified view of the patient’s adnexa A magnified view of the patient’s adnexa

and anterior segment structures.and anterior segment structures. - Lid margins and lashes- Lid margins and lashes - conjunctiva- conjunctiva - sclera- sclera - cornea and tear film- cornea and tear film - anterior chamber, iris, lens and anterior- anterior chamber, iris, lens and anterior vitreousvitreous - retina, macula and optic nerve head- retina, macula and optic nerve head

VIII. OphthalmoscopyVIII. Ophthalmoscopy

DirectDirect IndirectIndirect