lecture4 subjective and objective eye exam

OBJECTIVE AND SUBJECTIVE EYE EXAMINATION

Department of Ophthalmology

Fatima Medical Center

SUBJECTIVE EXAMINATION

• Disturbance in vision

• Ocular discomfort

• Abnormal ocular appearnace

• Abnormal ocular secretions

Time & manner of onset

• Chronic visual loss

• Acute visual loss

UNILATERALITY & BILATERALITY

Unilateral - e.g. trauma, vascular occlusion, secondary glaucoma

Bilateral- e.g. cataracts, age related macular degeneration (ARMD), diabetic retinopathy

SYMPTOMS

• Disturbance of vision– Blurring of central vision– Decreased peripheral vision– Altered image size/shape– Diplopia– Flashes and floaters– Iridescent vision– Color vision problems– Dark adaptation problems

• Ocular pain or discomfort– Foreign body sensation– Photophobia– Ciliary pain– Itching– asthenopia

• ABNORMAL SECRETIONS– Lacrimation/epiphora– Discharge– Dryness

ABNORMAL SIGNS

• Ptosis- drooping of the upper eyelid

• Proptosis- outward protrusion of an eyeball

• Enophthalmos- a “ sunken “ eyeball

• Blepharitis- infection of lid margin

• Strabismus- deviation of one or both eyes

• Redness – extreme vascularity of conjunctiva

• Opacity- disturbance of clarity

• Masses- tumor lesions

Objective examination• Visual acuity• External eye examination• Anterior segment examination• Pupils• Ophthalmoscopy• Occular motility• Tonometry• Visual field examination

Visual acuity

• Before anything else!!– Baseline– Legal purposes

• Exception:– Chemical burns– FLUSH!!

Visual acuity

• Uncorrected distance

• Corrected distance

• Pinhole test

• Near vision test

Snellen’s Chart

Visual acuity

• Distance acuity– Snellen chart– Illiterate E– Notation eg.

Visual acuity

• Distance acuity– Snellen chart– 20 feet or 6 meters away– Test one eye at a time– Use an occluder

Jaeger Chart

External eye examination

• Ocular adnexae

• Orbit

• Conjunctiva

External Eye

Blepharitis

Entropion

Ectropion

Membranous Conjunctivitis

Follicular Hypertrophy

Papillary Reaction

Lid mass

ptosis

Lid Eversion

Anterior segment examination

• Cornea

• Ant. Chamber

• lens

Corneal Abrasion

Slit Lamp Examination

PUPILS

• Direct reflex

• Consensual reflex

• Normal pupil size 3-4mm under normal illumination

OPHTHALMOSCOPY

• Direct ophthalmoscopy– Small field of view– Upright image– A large image size– No stereopsis

• Indirect ophthalmoscopy– Large field of view– Inverted image– Small image size– Stereopsis( depth perception of 3-

dimensionality)

OPHTHALMOSCOPY

• STRUCTURES– Optic nerve head- CD ratio of less than 0.3mm– Vessel caliber- AV ratio 2:3– Retina– Macula

OCCULAR MOTILITY

• 6 Cardinal Positions of Gazes

• Lateral rectus – (CN VI)

• Sup. Oblique- ( CN IV)

• the rest of the EOMs are innervated by CN III

Strabismus

TONOMETRY

• Normal IOP 10-22mmhg

• Applanation tonometry

• Schiotz tonometry

VISUAL FIELD EXAMINATION

• Confrontation test

• Automated perimetry e.g. Octopus, Humphrey