OBJECTIVE AND SUBJECTIVE EYE EXAMINATION
Department of Ophthalmology
Fatima Medical Center
SUBJECTIVE EXAMINATION
• Disturbance in vision
• Ocular discomfort
• Abnormal ocular appearnace
• Abnormal ocular secretions
Time & manner of onset
• Chronic visual loss
• Acute visual loss
UNILATERALITY & BILATERALITY
Unilateral - e.g. trauma, vascular occlusion, secondary glaucoma
Bilateral- e.g. cataracts, age related macular degeneration (ARMD), diabetic retinopathy
SYMPTOMS
• Disturbance of vision– Blurring of central vision– Decreased peripheral vision– Altered image size/shape– Diplopia– Flashes and floaters– Iridescent vision– Color vision problems– Dark adaptation problems
• Ocular pain or discomfort– Foreign body sensation– Photophobia– Ciliary pain– Itching– asthenopia
• ABNORMAL SECRETIONS– Lacrimation/epiphora– Discharge– Dryness
ABNORMAL SIGNS
• Ptosis- drooping of the upper eyelid
• Proptosis- outward protrusion of an eyeball
• Enophthalmos- a “ sunken “ eyeball
• Blepharitis- infection of lid margin
• Strabismus- deviation of one or both eyes
• Redness – extreme vascularity of conjunctiva
• Opacity- disturbance of clarity
• Masses- tumor lesions
Objective examination• Visual acuity• External eye examination• Anterior segment examination• Pupils• Ophthalmoscopy• Occular motility• Tonometry• Visual field examination
Visual acuity
• Before anything else!!– Baseline– Legal purposes
• Exception:– Chemical burns– FLUSH!!
Visual acuity
• Uncorrected distance
• Corrected distance
• Pinhole test
• Near vision test
Snellen’s Chart
Visual acuity
• Distance acuity– Snellen chart– Illiterate E– Notation eg.
Visual acuity
• Distance acuity– Snellen chart– 20 feet or 6 meters away– Test one eye at a time– Use an occluder
Jaeger Chart
External eye examination
• Ocular adnexae
• Orbit
• Conjunctiva
External Eye
Blepharitis
Entropion
Ectropion
Membranous Conjunctivitis
Follicular Hypertrophy
Papillary Reaction
Lid mass
ptosis
Lid Eversion
Anterior segment examination
• Cornea
• Ant. Chamber
• lens
Corneal Abrasion
Slit Lamp Examination
PUPILS
• Direct reflex
• Consensual reflex
• Normal pupil size 3-4mm under normal illumination
OPHTHALMOSCOPY
• Direct ophthalmoscopy– Small field of view– Upright image– A large image size– No stereopsis
• Indirect ophthalmoscopy– Large field of view– Inverted image– Small image size– Stereopsis( depth perception of 3-
dimensionality)
OPHTHALMOSCOPY
• STRUCTURES– Optic nerve head- CD ratio of less than 0.3mm– Vessel caliber- AV ratio 2:3– Retina– Macula
OCCULAR MOTILITY
• 6 Cardinal Positions of Gazes
• Lateral rectus – (CN VI)
• Sup. Oblique- ( CN IV)
• the rest of the EOMs are innervated by CN III
Strabismus
TONOMETRY
• Normal IOP 10-22mmhg
• Applanation tonometry
• Schiotz tonometry
VISUAL FIELD EXAMINATION
• Confrontation test
• Automated perimetry e.g. Octopus, Humphrey