EYE

EXAMINATIO
N

BY
:
Gita Amalia
Asikin
 I11112
032
SUPERVISO
R:
dr. Muhammad
Asroruddin, Sp.M
 Steps in Basic Eye
Examination
1. Visual Acuity 2. Conjunctiva and
sclera
2. Pupillary
3. Cornea and iris
examination
6. Anterior chamber
3. Visual
depth
fields by
confrontati
on
4. Extraocular
movements
5. Inspection of
1. Lids and
surrounding tissue
7. Lens clarity 9. Fundus examination
8. Tonometry 1. Disc
2. Macula
3. Vessels

7/1/16
2
VISUAL
ACUITY
7/1/16
3
 Snellen eye chart

7/1/16
4
 Visual Acuity Testing
Nomenclature:
Distance between the pa<ent and the eye chart

Distance at which the le@er can be read by a person with

normal acuity

Snellen (m) Snellen (Ft) Decimal

6/6 20/20 1.0

5/6
6/9 20/25
20/30 0.8
0.7

5/9
6/12 15/25
20/40 0.6
0.5

5/12
6/18 20/50
20/70 0.4
0.3
7/1/16 6/60 20/200 0.1 5
Cont
Place patient at 6 m from Snellen
chart and close one eye that is not
tested.
VA is line in which > letters are
read
Average normal VA 6/4 6/6 m
(20/15
20/20 ft)
Cont
6/6 = patient can read at 6 m
with same accuracy as person with
normal vision.
6/60= patient can read at 6 m
what normal person can read from
60 m.
 Cant read at 6/60 Count fingers
Examiner moves until 5 m away from
patient patient can identify the number
of fingers VA = 5/60
If still cant move 1 m forward each
time and try again until examiner is 1 m
away from patient.
Cant identify the number of fingers
at 1/60
Hand
motion
VA = 1/300
 Cant see the hand motion Light
perception
Yes VA = 1/~
No VA = 0
 Pinhole
Test
Determine problem with is the of
refractive
if a (and thus
acuity with
result o
error
due to organiccorrectable
disease. glasses) r
Better Refractive error
Same/worse Organic disease

7/1/16 8
 Refractive Error
Correction
Determine the distance between
right pupil and left pupil (PD)
Hold a ruler in front of the eyes.
Light between the eyes from >30 cm
(distance PD) and 30 cm (near PD). See
the light reflex on each corneas eye.
Measure the distance between those
light reflex.
7/1/16 9
Cont
Determine the power of sefris lens
(dioptre)
Put on trial frame at the right position
(distance PD)
Put on the occluder in front of the eye
that wont be tested yet
Ask patient to see the Snellen Chart
Put on the trial lens (S- or S+ lens) and
add the lens
power until patient gets the best vision.
If myopia choose the lowest S- lens that
can give the best visual acuity
Cont
If hypermetropia choose the highest S+
lens
 If presbyopia
Use near PD
Choose S+ lens according patients age
40 y.o. S+1.00
45 y.o. S+1.50
50 y.o. S+2.00
55 y.o. S+2.50
60 y.o. S+3.00
Try to read from the right distance
for reading
(+30cm)
7/1/16
12
 PUPILLARY
EXAMINATION
7/1/16
13
 Pupillary
Examination
Describe
PRRA
Pupils Equal
Insokor or anisokor
d normal = 3-5 mm, <2 mm =
myosis, >5 mm
= mydriasis
7/1/16 14
Round
Draw pupils if theyre not
round/irregular

7/1/16 15
 Pupillary Examination
Technique
Reactive to
Light
Direct penlight into eye while
patient looking at distance
Direct
Constriction of ipsilateral eye
Consensual
Constriction of contralateral eye
7/1/16 15
7/1/16
16
Cont
Accomodation
Patients eyes follow examiners
finger brought in towards them,
directly in middle
The eyes should converge and the
pupils will constrict (accommodation)

7/1/16 17
 VISUAL FIELDS BY
CONFRONTATION

7/1/16 18
Ask the pt to cover
one eye
Cover your
opposite eye
Ask the pt to look
straight ahead
Place one hand in
the plane be t w e e n t
he pat ie nt and t he
examiner out of your vision
Move the hand and ask
the patient when he/she can
see your hand

7/1/16 19
Both eyes should be
checked for stimulation
simultaneously.

7/1/16 20
EXTRAOCULAR
MOVEMENTS
7/1/16
20
 Extraocular Muscles and Direc<on of
Movement

Ask the pt to hold his/her head still and to follow

your finger with their eyes
Eye movement dependent on Cranial Nerves 3,
4, and 6 &
 muscles they innervate.
SO 4, LR 6, All the rest 3
7/1/16
21
INSPECTIO
N
7/1/16
22
 Inspects external ocular (eye) structures (lids,
conjunctiva, iris, cornea, pupils)

7/1/16 23
 Gently moves eyelids up and down to obtain a
better view

7/1/16 24
 Observation External Structures
Pupil, iris and eyelids & lashes should appear
symmetric
Sclera should be white
Conjunctiva clear

7/1/16 24
ANTERIOR CHAMBER
DEPTH
7/1/16
25
 Shine a light from the temporal side
of the head across the front of the
eye parallel to the plane of the iris.
Look at the nasal aspect of the iris. If
two thirds or more of the nasal
iris is in shadow, the
chamber is probably shallow and
the angle
narrow.
7/1/16
26
 LENS
CLARITY
7/1/16
27
 Light pupil from the front. See the
colour of the pupil.
Pupil is black
Clear lens
Aphakia
Pupil is white or grey : unclear/cataract
Light iris from the temporal side of
the eye (about
45o angle from the horizontal line of
iris). See the pupils again!
Pupil still white mature cataract (shadow
test (-))
Pupil turns into black immature cataract
(shadow test
 (+))

7/1/16
28
7/1/16
29
TONOMETR
Y
7/1/16
30
 Digital
Tonometry
the method of
Palpation estimating
(also known asintraocular
digital
pressure by gently pressing
tonometry) is the
index finger against the cornea of
a closed eye.

7/1/16 31
 Schiotz Tonometry
Instil local anaesthetic eye drops and
wait about 30 seconds.
Ask the patient to look at a fixed object and
to keep absolutely still.
With the thumb and index finger of one
hand, gently hold open the patient's
eyelids, taking care not to put any pressure
on the eye.
With the other hand, hold the tonometer
between the thumb and index finger and
place the plunger on the central cornea.

7/1/16 32
 Allow the disc to lower gently onto the
corneal surface.

7/1/16 33
7/1/16
33
 FUNDUS
EXAMINATION
7/1/16
34
 Direct Opthalmoscope

Holding the
Opthalmoscope

7/1/16 35
 Use the index nger to change lenses
(diopters)

7/1/16 36
 Darken the
room
Place the opthalmoscope to 0
diopters
Keep index finger on lens disc
Use R hand for pts R eye and L
hand for pts L eye
Ask pt to fix gaze on a spot on the
wall
Observe the red reflex and
then move in closer
You may rest your opposite hand
on the pts forehead above the eye
to help guide
Move the opthalmoscope very
close to the pts eye

7/1/16 36
 If you initially see blood
vessels, you can follow the blood
vessels toward the disc.
Diopters may need to be adjusted
to obtain a good focus

7/1/16 37
 The Retina (fully viewed)
Optic Disc Optic Cup Nasal
Temporal

Structures To Note:
1. Color of retina
(orange-ish)
2. Arteries (smaller)
3. Veins (darker)
4. Optic Disc (head of
CN2)
5. Optic Cup (center of
disc)
6. Macula (sharpest
focus) center =s
fovea

Macula Artery Vein

Fovea

The cup-to-disc ratio should be less than 0.6.

Arterioles should be 2/3 to 4/5 the size of veins.
Next look in all 4 quadrants of the retina
Finally, look at the fovea and macula. This may be
accomplished by asking the pt to look at the light
7/1/16 37
ANEL TEST
7/1/16
38
FLUORESEIN
TEST
7/1/16
39
ISHIHARA
PLATES
7/1/16
40
 EYELID
EVERSION
7/1/16
41
THANK
YOU
7/1/16
42