Ocular Examination &

Investigation

DR. Sheriff Zaki

 :History & Case taking
• Personal history: name; age; sex; residence;
special habits
• Complaints: e.g. eye pain; headache; redness;
defective vision
• Present history: onset; course; duration
• Past history: eye operations; medication
• Medical history: D.M.; hypertension
• Family history: Myopia; squint; retinitis p.
 :Personal History
• Name: to get acquainted with the patient
• Age: certain diseases affect certain ages ex.
Primary open angle glaucoma  > 50 years,
PACG  > 35 years
• Sex: certain diseases affect females ex. Primary
angle closure glaucoma
• Job: certain jobs affect the eye ex. Cataract
• Residence: certain areas contain environmental
factors that affect the eye
 :Complaint(s) of the patient
• Eye pain: it is either
1- Stitching pain  corneal ulcer
2- Burning pain  conjunctival inflammation
3- Dull aching pain  iridocyclitis
4- Bursting pain  acute congestive glaucoma
• Headache:
• Redness: Red eye syndrome
• Defective vision:
 :Present History
• Onset: it is either
1- Sudden: ex. Sudden loss of vision  CRA

occlusion
2- Rapid: ex. CRV occlusion  rapid painless

diminution of vision
• Course: it is either
1- Progressive 
2- Regressive
3- Stationary
• Duration:
 :Ocular examination
• External examination
• Anterior segment examination
• Posterior segment examination
• Testing visual acuity
• Measuring of intraocular pressure (IOP)
• Examination of the extraocular muscles
• Special ophthalmological examinations
 External examination
• It is important to stand back and observe
the patient's eyes:
1- Look at the eye lid symmetry and swellings
2- Are the eyes shrunken or protruding?
3- Is the conjunctiva red or not?
4- The upper eye lid must be everted to search
for a foreign body or examine the palpebral
conjunctiva
 Testing visual acuity
• Visual acuity for far vision is tested by:
- Landoll test [C pattern] - Snellen test [E pattern]
• Expressed by fraction :
numerator / denominator
= distance between chart & the patient /
smallest line seen at that distance
e.g. 6 / 6 ----- 6 / 60
If < 6 / 60 : 5 / 60 ----- 1 / 60
If < 1 / 60 : counting fingers, hand movements,

PL, no PL
• Visual acuity for near vision : read charts
 Anterior segment examination
• General examination in a good diffuse
light
• Examination of focal (oblique) illumination
using corneal loupe, binocular
• Examination of angle of A.C by
gonioscope or the Gold-man 3-mirror test
 Posterior segment (Fundus) examination
• Direct ophthalmoscopy: (magnification 15 times)
advantages: high magnification
disadvantages:
1- mononuclear vision
2- Narrow field
3- Can not be used for surgery or examination of the
peripheral fundus
• Indirect ophthalmoscopy: (magnification 5 times)
advantages:
1- Wide field
2- Binocular stereoscopic vision
3- Can be used for surgery & examination of the
peripheral fundus
• Fundoscopy (slit-lamp ophthalmoscopy):
 Measurement of IOP
• Digital method
• Indentation tonometry (schoitz)
• Applanation tonometry (Gold-man)
• Non-contact (air) tonometry
 :Ocular Investigations

• Ultrasonography
• Perimetry
• Fundus fluorescein angiography
• Electrophysiological studies
 :Ultrasonography
1- Examination of post. Segment in opaque
media
2- Detection of IOFB (site & nature)
3- Diagnosis of orbital diseases (Thyrotoxic
4- Measurement of axial length of the eye
(A- scan)
 (Perimetry (Visual field testing
(Gold-mann or automated peimetry)
• Diagnosis & follow up of glaucoma
• Diagnosis & follow up of optic n. diseases
• Diagnosis & follow up of retinal diseases
• Neuro-ophthalmological disorders
Fundus Fluorescein Angiography
• For diseases of retina & choroid:
1- Vascular occlusions (CRAO, CRVO)
2- Diabetic retinopathies
3- Macular diseases
4- Sub-retinal choroidal neovascularization
5- Retinal & choroidal neoplasms
 Electro-physiological studies

(ERG, EOG, VEP)

• Diagnosis of hereditary retinal diseases
• Evaluation of potential retinal functions in
eyes with opaque media
• Diagnosis of optic n. diseases
• Detection of malingering
 ‫ تجميعات‬M.C.Q.
• Uses of Gold-mann three mirror contact lens
1- Examination of fundus
2- Examination of the angle
3- Laser treatment of retinal diseases
• Uses of slit-lamp:
1- Examination of A.C
2- Examination of P.C
3- With specific contact lens  Fundoscopy
4- Measurement of IOP