Eye Examination

Last updated 03.11.12

 

Index

 

Definition

-  Examination of the eye

 

Features

-  Part of neurological examination

-  Patient should be seated

 

 

 

eye

 

Equipment

-  Pen torch

-  Snellen or Sheriden-Gardiner charts

-  Cotton buds

-  Fluoerescin & blue light

-  Local anaesthetic drops

-  Mydriatic

-  Othalmoscope

-  +/- Slit lamp

-  +/- Tonopen

-  +/- Amsler grid

 

General Inspection

-  Horners syndrome: Pancoasts tumour

-  Anhidrosis, miosis, ptosis

-  Exophthalmos/Proptosis: Graves disease

-  Axis/Symmetry: opthalmoplegia, amblyopia

-  Anterior chambers

-  Hyphema

-  Empypon

 

 

-  Eye Lid

-  Ptosis: myasthenia

-  Dalrymple sign (lid lag): hyperthyroidsm

-  Sclera visible above limbus

-  Von Graefe’s sign (lid retraction): hyperthyroidsm

-  Sclera visible above limbus

-  Red eye

-  Pupils

-  Pupil Changes

-  Aniscoria

-  Miosis (constriction)

-  Mydriasis (dilation)

-  Colomboma

-  PEARL

-  Afferent papillary defect

-  Blown pupil

-  Leukocoria (white red reflex)

-  Fundoscopy

-  Exudates

-  Papilloedema: IICP: Malignant HTN, Pre-eclampsia (severe)

 

Palpation

-  Orbits: trauma

-  Eyeball

-  Tenderness: glaucoma, uveitis, ant sleritis, foreign body

-  Tonopen/Slit lamp tonometry: increased intraocular pressure: glaucoma

-  Pressure: glaucoma

 

Visual Acuity

-  Glasses on if used for distance +/- pinhole

-  Good eye first

-  Cover eye not being tested

-  Snellen Chart at 6 or 3m

-  OR Tumbling Es (if unable to read)

-  Read smallest line

-  Record acuity 6/x

-  6/6 = read at 6m what avg read at 6m

-  6/18 = read at 6m what avg read at 18m

-  6/18+2 = all of 6/18 line + 2 of 6/12

-  CF = count fingers at x metres

-  HM = hand motion at x metres

-  LP = light perception

-  NLP = no light perception

 

 

Visual Fields

-  Blind spot

 

Fundoscopy

-  Cornea, retina, w dilation

-  Luekocoria

 

Slit Lamp Examination

-  Foreign body

-  Corneal epithelial defect

-  Anterior chamber: cells, flare..

 

+/- Amsler Grid: AMD

 

Cranial Nerves III, IV, VI (3, 4, 6:  Occulomotor, Trochlear, Abducens)

-  Light Reflex

-  Direct & consensual

-  Swinging torch test

-  Accommodation

-  Convergence

-  Eye Movements

-  Accommodation (far, near)

-  Convergence (w mitosis)

-  Confrontation (H)

-  Diplopia or nystagmus

-  Corneal Reflex

-  CNV (5) (V1: Opthlamic) afferent/sensory

-  CNVII (7) efferent/motor

-  Light touch to cornea causes bilateral blink

-  If blink present CNV intact

-  Ipsilateral: blink reflex

-  Contralateral: consensual reflex

 

Opthalmology Referral

-  Presenting w S/S in single good eye