Eye Examination

by right, the complete eye examination includes

• visual acuity test
• external eye examination
• anterior segment examination
• posterior examination

visual acuity

Visual acuity test is done using the Snellen's Chart - the examinee will stand 6 meters away from the chart, and indicate the Words pointed.
shall the patient be wearing the chart, examiner may check if the top letter on chart is visible at all without the glasses. 

ask patient to cover eye with the palm of the hand, not the fingers.

pin-hole will provide evaluation of the visual acuity - if there is a refractive error or medial opacities etc. when using pin-holes, patients with refractive error will have improved visual acuity.

you will need to document if the visual acuity examination was "corrected" visual acuity or "uncorrected" visual acuity. 

shall the patient unable to see the largest chart at 1 meter, you may use the counting finger method. - you will document the distance at which patient can count finger.

shall the patient unable to count fingers, you may want to examine if the patient may be able to perscieve hand movement.

shall the patient unable to percieve hand movement, examine if the patient can perscieve light.

If the patient cannot perscieve light the patient is said to be NPL - No Perception of Light.

Visual Field Examination

visual field examination is a part of visual acuity assessment. it includes;

• confrontational method
• perimetry

in visual field examination, we test the peripheral vision. - in macular diseases, the central vision may be impaired but peripheral vision intact.

the importance of visual field examination being the peripheral vision loss will go unnoticed compared to central vision loss.

confrontational method

sit at one arm's length, level to the patient. ask the patient to cover one eye - and examiner will cover the ipsilateral side. (if patient cover left eye, you will cover your right eye)

(rather difficult to explain, very clear if seen on video)

ocular motility and alignment

the "primary gaze" is the position of the eye when looking at an object in front. secondary gaze is up/down or left/right. the tertiary gaze is the diagonal movement - right upper, left upper, right inferior and left inferior.

it is important to recognize which ocular muscle is responsible for which gaze.

External Eye Examination

external eye examination starts with inspection of face, orbit and periorbital region.

• head / face orientation
• examination of face, orbit and adnexae
• position of globe

Anterior Segment Examination

Anterior Segment Examination include inspection of the following - 

• eyelids
• conjuctiva
• cornea
• anterior chamber
• iris
• lens
• anterior vitreous

to test for squint, you may shine a light directly infront of the patient and ask patient to look ahead. the light should be reflected on the center of the pupils. if there is a squint, there will be assymetry of reflection on the pupil.

Posterior Segment Examination

• posterior vitreous
• retina examination

posterior segment Examination is, basically - the use of opthalmoscope.

-to be updated-