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Anamnese and

Examinating Eye
By: Sayed Hamzah

ANAMNESE

Main complaint

Red eye, decreased visual acuity


Red eyes, good vision
Calm eyes, sudden decreased vision
Calm eye, visual acuity decreased slowly

History of present illness / first (duration, frequency, intermittency, and rapidity of


onset, location, the severity)

Eye medication used

Systemic - Disease? Surgery?

- Systemic Drugs in use

history of allergic

family history

Physical Examination

Ocular history : Chief complaint, past medical history, family history

External examination

Visual acuity

Visual Fields

Fundoscopic Examination

Ocular history

Chief complaint: duration, frequency, intermittency, and


rapidity of onset.

Past medical history: general state of health and principal


systemic illnesses.

family history is pertinent for ocular disorders, such as


strabismus, amblyopia, glaucoma, or cataracts, and retinal
problems, such as retinal detachment or macular degeneration.
Medical diseases such as diabetes may be relevant as well.

External Inspection

Inspect the lids, surrounding tissues, and palpebral fissure. Palpation of


the orbital rim and lids may be indicated, depending on the history and
symptoms.

Inspection of the conjunctiva and sclera is facilitated by using a penlight


and having the patient look up while the examiner retracts the lower lid
or look down while the examiner raises the upper lid.

Upper lid eversion


The patient is asked to look
down and the examiner grasps
the eyelashes of the upper lid
between the thumb and the
index finger. A cotton-tipped
applicator is used to press
gently downward over the
superior aspect of the tarsal
plate as the lid margin is pulled
upward by the lashes.

Bulbar conjunctiva

Alignment examination

Cornea

Placido test

Fistel test

TES FLUORESCEIN

Anterior Chamber

Steps to assess anterior


chamber depth:

1.

Shine a light from the


temporal side of the head
across the front of the eye
parallel to the plane of the
iris

2.

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

Pupillary examination

Pupil size
Observe reflection of pen light in both pupils. Is it symmetrical?
Test the papillary response to light

Direct response pupil constricts in examined eye


Consensual (Indirect) response pupil constricts in the opposite eye

Swinging Flashlight Test

A bright light is placed in front of one eye and moved quickly to the other
eye, then one or two seconds later moved quickly back to the first eye.
The pupils should remain constricted when the light is taken from one
eye quickly to the other

Visual acuity

Snellen Chart (Normal visual acuity is 5/5 (20/20)

Counting fingers

Hand movement

Light perception

Snellen Chart
If pt. wears glasses and
are not available use
pinhole testing.
If patient cannot read,
then document number
of fingers held up.
Hand motion at 2 ft.
If fails hand motion,
document light
perception

Visual fields

Ask the pt to cover one eye

Cover your opposite eye

Ask the pt to look straight


ahead

Place one hand in the plane


between the patient and the
examiner out of your vision

Move the hand and ask the


patient when he/she can see
your hand

Confrontation test

Ocular movements
Six Cardinal Positions of Gaze

Fundoscopic Examination
Darken the room
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
From about 15 away and about 15o
lateral look into pts eye
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
If you initially see blood vessels, you
can follow the blood vessels toward
the disc.
They flow like rivers toward the disc.
Diopters may need to
focus

be adjusted to obtain a good

Once you see the disc, you should note its color and note what percent of the
physiologic cup involves the disc.

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

You should note the size of the arterioles as compared to the veins. They 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

Other examinations

Perimetry/campimetry

Tonometry

Exophthalmometry

Anel test

Schrimer test

Color vision

Campimeter

Digital palpation

Schiotz Tonometer

Anel Test

Hertel Exophthalmolmeter

Schirmer test

Color vision tests (Ishihara)

Thank You