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This document describes the steps and equipment used in a standard eye examination. It involves testing visual acuity using an eye chart from distances of 6 meters and 1 meter. The examiner evaluates ocular motility by having the patient follow a light in 9 positions of gaze. Binocular alignment is assessed using a cover test. The conjunctiva, cornea, anterior chamber, lens, and retina are directly examined. A confrontation test provides a gross screening of visual fields.
This document describes the steps and equipment used in a standard eye examination. It involves testing visual acuity using an eye chart from distances of 6 meters and 1 meter. The examiner evaluates ocular motility by having the patient follow a light in 9 positions of gaze. Binocular alignment is assessed using a cover test. The conjunctiva, cornea, anterior chamber, lens, and retina are directly examined. A confrontation test provides a gross screening of visual fields.
This document describes the steps and equipment used in a standard eye examination. It involves testing visual acuity using an eye chart from distances of 6 meters and 1 meter. The examiner evaluates ocular motility by having the patient follow a light in 9 positions of gaze. Binocular alignment is assessed using a cover test. The conjunctiva, cornea, anterior chamber, lens, and retina are directly examined. A confrontation test provides a gross screening of visual fields.
I11111049 Equipment Direct ophthalmoscope for examining the fundus Focused light for examining the reaction of the pupil and the anterior chamber. Aspheric lens for examining the anterior chamber. Eye chart for testing visual acuity at a distance of 5 meters (20 feet) Sterile cotton swab for eyelid eversion Equipment 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 eye. 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 source. 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 moist. 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 anteriorly 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. Ophthalmoscopy 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 focus. 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 Ophthalmoscopy 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 THANK YOU