Eye Physical Exam

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Position: sitting
  • Proper exposure of both eyes
  • General inspection of the pt and surroundings
  • Any step that you do to one eye, mention that you should repeat with the other eye

 

A. Visual Acuity:

  1. Snellen chart
    • Sit the patient 6 m (20 ft) from the chart
    • Ask pt to keep their glasses\lenses on
    • Start with the good eye, cover the bad eye
    • Ask the pt to read the lowest line they can: “I’ll continue until the pt can see the lowest line and record the visual acuity”
      • Consider having the pt to read using a pinhole, to see if this improves vision (if improved, it suggests a refractive element)
      • If can’t read the top line at 6 m -> reduce the distance to 5,4,3,2, 1 m -> counting fingers (at 70, 50, 30 cm) -> hand movements ->
      • If can see hand motion -> light projection (quadrantes)
      • If can’t see hand motion -> light perception (by dimming the room) -> if still can’t see; say “no light perception”
  2. Fine print reading (only mention)
  3. Color vision using Ishihara cards (only mention)

 

B. Inspection: (sit in front of the pt)

  • Position and alignment of the eyes, squint\strabismus
  • Eyebrows, eyelids
  • Conjunctiva and sclera
  • Cornea, iris, and lens
  • Mention: if there’s any abnormality I’ll palpate it

 

C. Visual Field:

  • Sit facing the pt with the same eye level, ask the pt to cover one eye w\ ipsilateral hand and have them look at your nose, with you mirroring the pt
  1. Gross\central visual field loss: ask the pt if any part of your face is missing or distorted
  2. Peripheral visual field loss: by quadrants
  3. Visual neglect: wiggling fingers
  4. Blind spot: (only mention)

 

D. Extra-ocular Muscles Motility:

  • Sit facing the pt with the same eye level, ask the pt to cover one eye w\ ipsilateral hand and have them look at your nose
  • Do the “H” formation, and ask the pt if they experience double vision
  • Mention:
    • Normal pursuit, no nystagmus
    • If there’s any limitation, I’ll do duction test for the affected eye
    • Cover \ uncover test if indicated

 

F. Accommodation:

  • Far-near test

 

G. Pupillary Reflexes: using a torch

  • Dim the light, remove glasses\lens
  • Direct + consensual + swinging
  • Mention: Pupils are equal, round, and reactive to light and accommodation”

 

H. Red Reflex: using an ophthalmoscope

  • Dim the light, remove glasses\lens, set ophthalmoscope to “0”
  • Stand at an arm’s length from the pt, and ask them to look directly at the light

 

I. Fundoscopy: using an ophthalmoscope

  • Dim the light, remove glasses\lens
  • Ask the pt to focus on a specific point on the wall
  • Place your finger on the focusing ring -> “hold w\ my Rt hand, look with my Rt eye at pt’s Rt eye
  • Place your hand on the pt’s head, and come temporally
  • Look at:
    • Vessels: follow them to the disc
    • Disc: cup, color, contour
    • Macula: by asking the pt to look at the light
  • Mention: if facing difficulty, pt’s pupils should be dilated w\ short acting mydriatic eye drops

 

J. Intra-ocular Pressure: normal is 10-21mmHg

  • Either by; two principles:
    • Indentation: digital palpation, tono-pen, Schoitz tonometer
    • Applanation: Goldmann tonometry, air puff tonometer

 

K. Slit Lamp:

  • Examine the lids, lid margin, lacrimal system, conjunctiva, sclera, cornea, AC, iris
  • Put short acting mydriatic eye drops, wait 20 minutes, come back to the lamp
  • Look at the lens, vitreous

 


Download the PDF version: here 

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