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Eye Examination

Muhammad Luthfi Taufik

Direct ophthalmoscope for examining the
Focused light for examining the reaction of
the pupil and the anterior chamber.
Aspheric lens for examining the anterior
Eye chart for testing visual acuity at a distance
of 5 meters (20 feet)
Sterile cotton swab for eyelid eversion
Visual Acuity
Visual acuity, the sharpness of distance vision,
is tested separately for each eye.
One eye is covered with a piece of paper or
the palm of the hand placed lightly over the
The patient is first asked to identify certain
visual symbols referred to as optotypes at a
distance of 6 meters or 30 feet (test of
distance vision).
Visual Acuity
If the patient cannot discern the symbols on
the eye chart at a distance of 6 meters , the
examiner shows the patient the chart at a
distance of 1 meter.
If the patient is still unable to discern any
symbols, the examiner has the patient count
fingers, discern the direction of hand motion,
and discern the direction of a point light
Visual Acuity
Visual Acuity
Ocular Motility
With the patients head immobilized, the
examiner asks the patient to look in each of
the nine diagnostic positions of gaze: 1,
straight ahead; 2, right; 3,upper right; 4, up;
5, upper left; 6, left; 7, lower left; 8, down;
and 9, lower right
This allows the examiner to diagnose
strabismus, paralysis of ocular muscles, and
gaze paresis.
Ocular Motility
Binocular Alignment
Binocular alignment is evaluated with a cover test.
The examiner holds a point light source beneath his or
her own eyes and observes the light reflections in the
patients corneas in the near field (40 cm)
The reflections are normally in the center of each pupil.
If the corneal reflection is not in the center of the pupil
in one eye, then a tropia is present in that eye.
Then the examiner covers one eye with a hand or an
occluder and tests whether the uncovered eye makes a
compensatory movement.
Binocular Alignment
Conjunctiva Examination
The conjunctiva is examined by direct inspection.
The bulbar conjunctiva is directly visible between
the eyelids; the palpebral conjunctiva can only be
examined by everting the upper or lower eyelid.
The normal conjunctiva is smooth, shiny, and
The examiner should be alert to any reddening,
secretion, thickening, scars, or foreign bodies.
Conjunctiva Examination
Cornea Examination
The cornea is examined with a point light source
and a loupe .
The cornea is smooth, clear, and reflective.
Epithelial defects, which are also very painful, will
take on an intense green color after application of
fluorescein dye.
Sensitivity is evaluated bilaterally; The patient
looks straight ahead during the examination; The
examiner holds the upper eyelid to prevent
reflexive closing and touches the cornea
Cornea Examination
Anterior Chamber Examination
Inspect the anterior chamber. The anterior
chamber is filled with clear aqueous humor.
Evaluate the depth of the anterior chamber.
In a chamber of normal depth, the iris can be
well illuminated by a lateral light source
Anterior Chamber Examination
Lens Examination
The ophthalmologist uses a slit lamp to examine
the lens or focused light if necessary.
Direct illumination will produce a red reflection of
the fundus if the lens is clear and gray shadows if
lens opacities are present.
The examiner then illuminates the eye laterally
with a focused light held as close to the eye as
possible and
inspects the eye through a +14 diopter loupe .
With severe opacification of the lens, a gray
coloration will be visible in the pupillary plane.
Direct ophthalmoscopy. The ophthalmoscope is held as close to
the patient as possible.
Refractive errors in the patients eye and the examiners eye are
corrected by the ophthalmoscope lens to bring the retina into
The examination should be performed in a slightly darkened room
with the patients pupils dilated.
Identify the optic disk. In a normal eye, it is sharply defined
structure with vital coloration (i.e., yellowish orange) at the level of
the retina and may have a central excavation.
The central vein lies lateral to the artery; venous diameter is
normally 1.5 times greater than arterial diameter.
Younger patients will have a foveal and macular light reflex, and the
retina will have a reddish color
Confrontation Test
Confrontation testing provides gross screening of the field
of vision where perimetry tests are not available
The patient faces the examiner at a standard distance of
1mwith his or her eyes at the same level as the examiners.
Both focus on the others opposite eye (i.e., the patients
left eye focuses on the examiners right eye) while covering
their contralateral eye with the palm of the hand.
The examiner moves an object such as a pen, cotton swab,
or finger from the periphery toward the midline in all four
quadrants (in the superior and inferior nasal fields and
superior and inferior temporal fields).
Confrontation Test