EYE  EXAM

 

Visual Acuity:

  1. Always examine the "good" eye first. (It is easier for the patient to understand the test).
     
  2. In adult Snellen's chart placed 20 feet or Pocket chart - 14 inchs away and patient asked to read smallest discernable line.
     
  3. In  newborn, suspected malingerer or patient with  psychological blindness, use optokinetic reflex (rotating dram). If vision is intact nystagmus will occur.

 

External  Exam:

  1. Describe condition of structures surrounding each eye (periorbital area,  lids/motility, lacerations, lesions)

 

Eye Movement:

  1. CN III, IV and VI are tested by having patient move the eye in 6 cardinal directions (right, left, up/right, up/left, down/right, down/left) – if restricted call ophthalmologist or perform forced duction test

 

Pupil Exam:

  1. Includes description of size, shape (irregular shape commonly indicates previous surgery/trauma) and reaction to light.
     
  2. Check pupillary reaction to the direct light  as well as to the accommodation ( tested by having pt look at an object that is then beought closer. Pupil constricts when object is brought closer).
     
  3. Not uncommonly, patient may have anisocoria. This could be pathological or physiological. If this is physiological, each pupil will constrict equally (anisocoria will remain the same after  constrication).

 

Confrontational Visual Field Exam:

  1. face the patient @ 30 cm
     
  2. close opposite eyes (both Pt. and investigator)
     
  3. focus Pt's eye on the opposite one of investigator
     
  4. gradually move your finger from outside to inside until pt will indicate that he sees the finger (not just movements or shadow)
     
  5. repeat from horizontal, vertical and oblique  meridians.
     
  6. estimate  pt's field according to yours (when you start to see the finger, assuming yours is normal)

 

External  Exam:

  1. Describe eye lids (shape, motility, lacerations or other changes)
     
  2. Describe periorbital area  (edema/cellulitis, Raccoon eyes, dacriocystitis/adenitis etc.)
     
  3. Describe position of the eye (enophtalmus, exophtalmus, deviation etc)
     
  4. Describe pupils:  dilated/constricted, diameter (Horner's),  reactive symmetrically or not, presence of Relative Afferent Pupillary Deffect - RAPD ( checked by swinging test: swing flesh light from one eye to the other – if one significantly constricts after swing, but the other either dilates or just stays practically the same – consult opthalmologist)

 

Slit Lamp Exam:

  1. allows the magnified visualization of  an eye and adnexa
    .
  2. allows detection  of  corneal or conjunctival epithelial defects when fluorescein is applied and blue light of  a slit lamp is used.

 

Ophthalmoscopy:

  1. usually performed  by ophthalmologist, but when urgently needed could  be done  by ER MD either without pupillary dilation  or with  dilation after making sure that the anterior chamber of the eye is deep (by biomocrospy on a slit lamp).

 

IOP (intraocular pressure):

  1. determination can be done with "Tono-Pen"

[BACK]