How to Examine the Eye in Family Practice

Sarah Welch

GP CME 2014

Introduction

• Equipment and drops

• History

• Examination

• Management

Equipment

Drops

Tools for Management

History

• Change in Vision

• Ocular Discomfort

• Change in Ocular Appearance

• Trauma

Change in Vision

• Timing– Gradual– Sudden– Fluctuating

• Time of day – morning/ evening/ dark/light

• Disturbance– Central loss– Distortion– Field loss– Flashes/floaters– Haloes

Ocular Discomfort

• Aching

• Burning

• Foreign Body sensation

• Glare

• Headache

• Pain on eye movements

Uveitis

Uveitis

Acute Angle Closure Glaucoma

Change in Ocular Appearance

• Red Eye

• Lid malposition

• Shrinking Eye

• Swollen Lids

• Unequal pupils

• Prominent Eye

Red Eye

Red Eye

Ectropion

Ptosis

Chalazion

Enophthalmos

Proptosis

Examination

• Vision

• Anterior Segment

• Posterior Segment

• Pupils and Red Reflex

• Eye Movements

• Visual Fields

Visual Acuity

• Well lit chart

• With Glasses on

• Use occluder

• Use a pin hole

• Standardised Distance

• Charts are available on line – Near, colour, snellen

Visual Acuity Terminology

• NPL

• LP

• HM

• CF

• 6/60 – 6/6

• ph, gl

Corneal abrasion

Corneal Foreign Body

• Subconjunctival haemorrhage

– maybe slightly gritty/dry feeling

• Treatment:

– Lubricants

Painless Red Eye

Subconjunctival Haemorrhage

Large Subconjunctival Haemorrhage

Pingueculum

Pterygium

• Scratchy/Gritty

• Aching

• Deep headache, nausea, vomiting

Painful Red Eye

• Chronic symptoms

• Often have blurring of vision with reading

• Worse in wind / air conditioning / cold

• Treatment– Lots of lubricants

– Blepharitis lid care

• Manage not cure

Dry Eye/Blepharitis

Blepharitis

• Scales around base of lashes (collarettes)

• Chronic irritation worse in mornings

Blepharitis

• Shiny anterior lid margin • Greasy scales

• Lashes stuck together• Hyperaemia of lid margin

Posterior Segment

• Symptoms

– Flashes

– Floaters

– Change in Vision

• Red Reflex

• Vision

• Projection/fields

Amsler Grid

Pupils

• Response to light

• RAPD

• Red Reflex

• Symmetrical

RAPD – Relative Afferent Pupillary Defect

Eye Movements

• Squints

• Loss of Eye Movement

– Nerve palsies

– Restriction

• Nystagmus

• Force of Injury

• Hammering Metal on Metal

• Grinding

• Abrasion

Trauma

Complications of blunt trauma

Sphincter tear

Cataract Angle recession

Hyphaema

Lens subluxation

Iridodialysis Vossius ring

Rupture of globe

Complications of penetrating trauma

Flat anterior chamber

Vitreous haemorrhage

Damage to lens and iris

EndophthalmitisTractional retinal detachment

Uveal prolapse

Management of intraocular foreign bodies

Removal by pars plana vitrectomy

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