Visual acuity

•is the essential part of the eye

examination

•measure against which all therapeutic

outcomes are based
Snellen Chart
• is used to test distance vision

•20/20 – normal vision

•most people can see the letters on the line

designated as 20/20 from a distance of 20 feet

•the patient is positioned at a prescribed distance,

usually, 20 feet from the chart and is asked to read
the smallest line that he or she can see

•each eye should be tested separately

•if the patient is unable to read the 20/20 line, the

patient is asked to read through a pinhole occluder

•OD-20/20; OS-20/15-2 or VA 20/20;20/15-2

External Eye
Examination
it is performed after the vision acuity has
been recorded

- the patient is examined for ptosis

(drooping eyelid) and for lid retraction
- the lid margins and lashes should
have no edema, erythema, or lesions
- the sclera is inspected- a normal
sclera is opaque and white
- lesions on the conjunctiva, discharge
& tearing are noted
- pupillary response is checked if the
pupils are equally reactive and regular
- the examiner observes nystagmus
- the extraocular movements of the
eyes are tested
Direct Opthalmoscopy

• a hand-held instrument with various plus

and minus lenses

• vasculature comes into focus first

• veins are larger in diameter than the arteries

• normal cup depression is about one-third

the size of the diameter of the disc

• last to be examined is macula- this area is the most sensitive to

the light
*the retina has a glistening effect referred to as a
cellophane reflex

•the examiner looks for any abnormalities like intraretinal

hemorrages, lipid, cotton-wool spots and microaneurysms
Indirect Opthalmoscopy

•used to see larger areas of

retina, although in an
unmagnified state
•it produces a bright and
intense light
Slit-Lamp
Examination
•a binocular microscope mounted on a
table

•enables the user to examine the eye

with a magnification of 10-40 times
the real image

•illumination can be varied from a

broad to narrow beam of light

•cataracts may be evaluated by

changing the angle of the light
Color Vision Testing
•the photoreceptor cells responsible for color vision are
the cones and the greatest are of color sensitivity is in the
macula, the area of densest cone concentration

•the most common color vision test is performed using

Ishihara polychromatic plates, these plate are bound
together in a booklet, on each plate of this booklet are
dots of primary colors that are integrated into a
background of secondary colors

•the dots are arrange in simple patterns

Amsler Grid
•is a test often used for patients with
macular problems

•consists of a geometric grid of identical

squares with a central fixation point

•grid should be viewed with normal

reading glasses and each eye is tested
separately

•the patient is instructed to stare at the

central fixation spot on the grid and
report any distortion in the squares of the
grid itself
Ultrasonography
•used to identify orbital tumors,
retinal detachment, vitreous
hemorrage, and changes in
tissue composition

Color Coherence
Tomography
•is used to evaluate retinal
and macular diseases as
well as anterior segment
conditions
Color Fundus Photography
•is used to detect and document any retinal lesions
•patient’s pupils are widely dilated during the procedure
•visual acuity is diminished for about 30 minutes due to retinal
“bleaching” by the intense flashing lights

Fluorescein Angiography
•an invasive procedure in which fluorescein dye is injected,
usually into an antecubital area vein. Within 10 to 15 seconds,
this dye can be seen coursing through the retinal vessels
Indocyanine Green
Angiography
•is used to evaluate abnormalities in the
choroidal vasculature, conditions often
seen in macular degeneration

•a green dye is injected intravenously, and

multiple images are captured using digital
videoangiography over a period of 30
seconds to 20 minutes
Tonometry
• measures IOP by determining the
pressure necessary to indent or flatten
a small anterior area of the globe of
the eye

• pressure is measured in millimetres

of mercury (mmHg)

• the procedure is non-invasive and

usually painless

• a topical anesthetic eye drop is instilled

in the lower conjunctival sac
Perimetry Vision
•it is visual field testing

•it helps identify which part of the

patient’s central and peripheral visual
fields have useful vision

•it is most helpful in detecting scotomas

(blind area in the visual field) in macular
degeneration and the peripheral field
defects in glaucoma and renitis
pigmentosa
 Eye Disorder

Clinical Manifestation of Eye Disorder:

•Blurred vision
•Diplopia
•Photopsia
•Floaters
•Scotomata
•Photophobia
• Loss of Vission
•Blurred vision
•Vision is blurred or misty from a lack of
sharpness or detail in the visual image.

•The most common cause of gradual blurring

is a refractive error that prevent light rays
from converging directly on the retina.

•Other problems originating in the eye that

can cause blurred vision are tear film
abnormalities, foreign bodies, inflammation of
ocular structure, cataract and glaucoma by
increased intraocular pressure that result in
optic nerve atrophy and blindness
•Blurred vision

•Systemic diseases that can cause

blurred vision include diabetes
mellitus, hypertension, and kidney
disease.
•It can also be caused by tobacco
and drugs, such as alpha blockers.
•Diplopia
•Is a term use to describe double
vision, or seeing one object as
two
•It is horizontal if the margin is
side by side and vertical if they
are above and below each other.
•In some situations transient
horizontal diplopia is caused by
weakness or paralysisof one or
more of the extraocular muscle
that can result from transient
ischemic attack, tyroid eye
disease, trauma, or such drugs
as alcohol impiramine, lidocaine.
•Photopsia
•Is the subjective appearance
of flashing light or in the
visual field
•This occurrence is
sometimes a forewarning of
retinal detachment.
 •Floaters
•Are minute particles in the vitrous seen by the
patient as stringy, wringgling moving spots or
black specs in the visual fluid.

•They occur because the particle cast a shadow

on the retina.

•They are common in nearsighted people and in

the aged.

•They tend to be most noticed when the person

is tired or worried
•Scotomata

•Are absolute, or fixed not moving blind spot in the

visual field
•They suggest retinal or neurological lessions
•They may also occur as dose dependent reaction to
drug such as steptomycin and sulfonamides
•Photophobia
•Is a universal intolerance to light that may or may not
reflect a pahtologic state

•is a symptom of excessive sensitivity to light and the

aversion to sunlight or well-lit places. In ordinary medical
terms photophobia is not a morbid fear or phobia, but an
experience of discomfort or pain to the eyes due to light
exposure.

•Light sensitivity is usually due to too much light entering

the eye, which causes over stimulation of the
photoreceptors in the retina and subsequent excessive
electric impulses to the optic nerve. This leads to a reflex
aversion to light, and discomfort or pain. Too much light can
enter the eye if it is damaged, such as with corneal
abrasion and retinal damage, or if a pupil(s) is unable to
normally constrict
•Loss of Vision

•Loss of ability to see may be gradual or sudden

in onset, permanent or temporary and may
involved all part of the visual field. Loss of vision
may result directly from ocular or orbit, dry of
unction, from neurologic or systemic disorders,
from trauma or from drugs. Sudden vision loss
in associated with retinal attachment, vitreous
hemorrhage and occlusion of the central retinal
artery or vein. Slow central loss in associated
with nuclear cataract and muscular
degeneration. Slow peripheral loss in
characteristic of open argu geaucoma.
Visual fluid defects
•Left anopia – total blindness on left
side of the eye
•Binasal Heminopia- blindness on
the nasal side of both visual field
•Bitemporal Hemianopia- blindness
on the both visual field.
•Right homonimous hemanopia-
blindness in the right side of each
visual field.
•Altitudinal hemanopia- blindness in
the upper, lower half of each visual
field
•Homonymous left lower- blindness
in the lower left quadrant of each
visual field.
 Disease of the
Eye
•Stye- painful swelling
appearing near the eyelid
margin
•Blepharitis- chronic
inflamation of the margin of the
eyelid
•Conjunctivitis- inflammation
of the conjunctiva
•Irashoma- common infection
of conjunctiva and cornea
•Keratitis- infection of the
cornea
Refractive Error

•Hypermetropia- far
sightedness
•Myopia- near
sightedness
•Astigmatism-
Distortion of vision
Role of eye Specialist

ophthalmologist refers to a
specialist in medical and surgical
eye problems. Since
ophthalmologists perform
operations on eyes, they are
considered to be both surgical
and medical specialists.
ophthalmologist

• specially trained in the

medical and surgical care
and treatment of the eyes.
•What Other Professionals
Care For The Eyes?

•Optometrists
•Opticians