Eye assessment

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  • 1. Rangsima Poomsawat Department of Public Health Nursing Faculty of Nursing Chiang Mai University E mail: rangsima@ chiangmai.ac.th http://www.facebook.com/RangsimaPoomsawat http://www.slideshare.net/rpoom http://www.youtube.com/RangsimaPoomsawat http://www.facebook.com/pages/Nursing-Room-By-Rangsima/109937325743807?v=wallOct/2008 rangsima@chiangmai.ac.th 1
  • 2. Contents 1. History Taking 2. Ocular Symptomatology 3. Visual Acuity Test 4. External Eye Examination 1. Eye Lids 2. Eyeball 3. Lacrimal System 4. Conjunctiva 5. Anterior Segment Examination 1. Cornea 2. Anterior Chamber 3. Iris 4. Pupil 5. Lens 6. Testing of Function of Extraocular MusclesOct/2008 rangsima@chiangmai.ac.th 2
  • 3. Oct/2008 rangsima@chiangmai.ac.th 3
  • 4. • The purpose of the interviewing a client is to obtain a health history. • Ask about the symptoms or other phenomena associated with the client’s chief problems or concerned and at the same time observes for signs in the client’s physical appearance or behaviors.Oct/2008 rangsima@chiangmai.ac.th 4
  • 5. • Introductory phase – To create a climate of trust to promote interaction – Introduce yourself : your full name, your role **This greeting respectfully acknowledges the clients and conveys your accountability as part of health care team – Describe your purpose of the interviewOct/2008 rangsima@chiangmai.ac.th 5
  • 6. • Working phase – You and the client should both be comfortably seated and facing each other during the interview. – To put the client ease, directly state that the information you obtain will be confidential, recorded in the medical record,and share with those directly involved in the care and treatment plan. – Take some note and complete final record later. – Eye Practitioner may be skillful in communication techniques to enable a client to share life experiences relevant to his health status.Oct/2008 rangsima@chiangmai.ac.th 6
  • 7. Interview Techniques Type of Questions – Opened ended : broad opening statements • Your concern today is….? • Tell me what bring you here today? – Closed ended : requires a response of one or two words,such as yes or no • Age, Marital status, Medication – Directive questions : lead the client to focus on one set of thought • Used in review of system or in evaluating functional health status. • Have you experienced any problem with urination in the past,such as infection ,unusual frequency, urgency, or difficulty urination? – Permission-giving questions • Asks client questions about sensitive area : Sexual transmitted infection • Let a client know that it is all right to speak such things to you.Oct/2008 rangsima@chiangmai.ac.th 7
  • 8. Interview Techniques Use of Silence Short period of silence allow the clients organize their thoughts. During silence period,you can observe the clients emotional state and note nonverbal cues. Silence may also indicate that either you or the client need time to reflect on what was just said.Oct/2008 rangsima@chiangmai.ac.th 8
  • 9. Validating Information From the Interview• Clarification : ask the client to clarify the thought or feeling• Restatement : involves repeating what the client has said using different word.• Reflection : repeat phrase or sentence the client just said.• Confrontation : make the client aware that what you observe is not consistent with he said.• Interpretation : share with the client the conclusion you have drawn from the information you obtained• Summary : summarize the information when terminate interviewOct/2008 rangsima@chiangmai.ac.th 9
  • 10. Nonverbal Communication• Body language : – Body Posture, Facial expressions are indicators of emotional states such as fear anxiety, surprise or joy• Eye contact – Avoid eye contact during interviewing may have anxiety• Interpersonal Distance : vary by the nature or cultural practice• Touch : express appreciation and trust by touch Oct/2008 rangsima@chiangmai.ac.th 10
  • 11. Organization of A History • Introductory Data • Chief complaint • Present illness • Past History • Personal History • Family History • Review of SystemOct/2008 rangsima@chiangmai.ac.th 11
  • 12. Introductory Data•Included under general information are the essential facts – Name, Address, Date of birth , Age, Sex – Occupation • Type of work • Industrial hazard Oct/2008 rangsima@chiangmai.ac.th 12
  • 13. Chief Complaint : CC The main reason for which the patient has come to the doctor for advice and help Include a notation of the duration of problem• Blurred Vision ****• Ocular pain (ocular ache) , Burn sensation ***• Discharge• Red eye• Itching• Changes in vision or visual fields• Difficulty reading• Oct/2008 cyst , stye , exophthalmos Etc : rangsima@chiangmai.ac.th 13
  • 14. Example of good statements of CC• “Blurred vision Right eye for 7 days”• “Headache and fever for 6 hours.”• “Vision test needed for work”Oct/2008 rangsima@chiangmai.ac.th 14
  • 15. Greater detail ofmain symptoms Present Illness :PI• Duration : – How long has this condition lasted? Is it similar to a past problem? If so, what was done at that time?• Onset : sudden or gradually• Severity/ Character – How bothersome is this problem? Does it interfere with your daily activities? – If they are describing pain, ask them to rate it from 1 to 10 with 10 being the worse pain of their life – When describing pain, ask if its like anything else that theyve felt in the past. Knife-like? A sensation of pressure? A toothache? – If it affects their activity level, determine to what Oct/2008 degree this occurs. rangsima@chiangmai.ac.th 15
  • 16. Present Illness : PI• Location/ Radiation : unilateral or bilateral – Is the symptom (e.g. pain) located in a specific place? Has this changed over time? If the symptom is not focal, does it radiate to a specific area of the body?• Pace of illness: Is the problem getting better, worse, or staying the same? If it is changing, what has been the rate of change?• Are there any associated symptoms? If so, whats made it better (or worse)?• Have they tried any therapeutic maneuvers? If so, whats made it better (or worse)?• What do they think the problem is and/or what are they worried it might be? Oct/2008 rangsima@chiangmai.ac.th 16
  • 17. Present Illness : PI• Why today? – This is particularly relevant when a patient chooses to make mention of symptoms/complaints that appear to be long standing. – Is there something new/different today as opposed to every other day when this problem has been present? – Does this relate to a gradual worsening of the symptom itself?Oct/2008 rangsima@chiangmai.ac.th 17
  • 18. Past History : PH• Past Ocular Problem /Trauma / Ocular surgery : repeat , chronic • Herpetic stromal keratitis • Aphakia , Lens Extraction• Visual acuity in the past / Eye glasses • Myopia , Presbyopia , Astigmatism• Past Medical History • Hypertension, Diabetic Mellitus, Thyrotoxicosis • Malaria, Tuberculosis **• Past Surgical History• Accident and disabling injuries• Hospitalization (including Blood transfusion)Oct/2008 rangsima@chiangmai.ac.th 18
  • 19. Past History : PH• Medications (ocular or other) • Mydriatics Myotics • Steroid • Ethambutol , Quinine, Chloroquine • Epinephrine , silver nitrate • Herbal preparation or nutrition supplementOct/2008 rangsima@chiangmai.ac.th 19
  • 20. Past History : PH • Allergies/Reactions – Environment :Inhalants Contactants – Food : Ingestants – Medication • Pediatric: – Growth and Development – ImmunizationOct/2008 rangsima@chiangmai.ac.th 20
  • 21. Personal History• Habits :Smoking / Alcohol /Caffeine/Drugs• Sexual ActivityOct/2008 rangsima@chiangmai.ac.th 21
  • 22. Family History : FH • Heritable illnesses • Color blindness , Retinoblstoma • Myopia ,Glaucoma • Chronic Disease • DM Hypertension • Communicable diseases(including family Sibling Sex partner) • HIV • TB • MalariaOct/2008 rangsima@chiangmai.ac.th 22
  • 23. Review of Systems• Health History : – Head and Neck – Thorax and Lung – Heart – Abdomen – Musculoskeletal – Neurological – MentalOct/2008 rangsima@chiangmai.ac.th 23
  • 24. Contents  History Taking  Ocular Symptomatology  Visual Acuity Test  External Eye Examination  Eye Lids  Eyeball  Lacrimal System  Conjunctiva  Anterior Segment Examination  Cornea  Anterior Chamber  Iris  Pupil  Lens  Testing of Function of Extraocular MusclesOct/2008 rangsima@chiangmai.ac.th 24
  • 25. Oct/2008 rangsima@chiangmai.ac.th 25
  • 26. Ocular Symtomatology • Visual Symptoms • Non-Visual SymptomsOct/2008 rangsima@chiangmai.ac.th 26
  • 27. Oct/2008 rangsima@chiangmai.ac.th 27
  • 28. Blurred vision • Monocular, Binocular • Sudden , Progressive • Distance : Near Far • Character • DurationOct/2008 rangsima@chiangmai.ac.th 28
  • 29. Blindness • VA < 6/60 • VF < 20 degree • Cause – Cataract – Glaucoma • Type – Cortical Blindness – PerceptualOct/2008 rangsima@chiangmai.ac.th 29
  • 30. Amsler’s Grid MetamorphopsiaOct/2008 rangsima@chiangmai.ac.th 30
  • 31. Visual Symptoms •Micropsia •MacropsiaOct/2008 rangsima@chiangmai.ac.th 31
  • 32. Iridescent VisionOct/2008 rangsima@chiangmai.ac.th 32
  • 33. ChromatopsiaOct/2008 rangsima@chiangmai.ac.th 33
  • 34. FloaterOct/2008 rangsima@chiangmai.ac.th 34
  • 35. DiplopiaOct/2008 rangsima@chiangmai.ac.th 35
  • 36. Photopsia Photophobia Visual Field DefectOct/2008 rangsima@chiangmai.ac.th 36
  • 37. Night Blindness Day Blindness Color BlindnessOct/2008 rangsima@chiangmai.ac.th 37
  • 38. Oct/2008 rangsima@chiangmai.ac.th 38
  • 39. Headache Ocular AcheOct/2008 rangsima@chiangmai.ac.th 39
  • 40. Burning Sensation Foreign Body SensationOct/2008 rangsima@chiangmai.ac.th 40
  • 41. Itching Pulling SensationOct/2008 rangsima@chiangmai.ac.th 41
  • 42. Red EyeDischarge Oct/2008 rangsima@chiangmai.ac.th 42
  • 43. Dry Eyes Lid SwellingOct/2008 rangsima@chiangmai.ac.th 43
  • 44. ExophthalmosDiscoloration Oct/2008 rangsima@chiangmai.ac.th 44
  • 45. Contents History Taking Ocular Symptomatology Visual Acuity Test External Eye Examination  Eye Lids  Eyeball  Lacrimal System  Conjunctiva Anterior Segment Examination  Cornea  Anterior Chamber  Iris  Pupil  Lens Testing of Function of Extraocular MusclesOct/2008 rangsima@chiangmai.ac.th 45
  • 46. • Assessment of the eyes ability to distinguish object details and shape, using the smallest identifiable object that can be seen at a specified distance (usually 20 ft. or 16 in.).Oct/2008 rangsima@chiangmai.ac.th 46
  • 47. • Finding normal VA >> – Clarity of cornea anterior body Lena Vitreous Humor – adequacy of macular (central vision) – Functioning of nerve fiber from macula to the occipital cortexOct/2008 rangsima@chiangmai.ac.th 47
  • 48. For distant vision Oct/2008 rangsima@chiangmai.ac.th 48
  • 49. For Near vision:• Near vision is tested by using a test card and each eye is tested individually.• The card has number of printed paragraphs with print of varying sizes. Each paragraph is described in terms of “points” measuring the body of the print – where a “point” is 1/72 of an inch.• In a common test, N48 is the largest type, and N5 is the smallest, which an unimpaired eye can see, held at a comfortable reading distance, (usually 14 inches), from the eyes.Oct/2008 rangsima@chiangmai.ac.th 49
  • 50. EquipmentOct/2008 rangsima@chiangmai.ac.th 50
  • 51. Oct/2008 rangsima@chiangmai.ac.th 51
  • 52. วัดสายตาOct/2008 rangsima@chiangmai.ac.th 52
  • 53. Oct/2008 rangsima@chiangmai.ac.th 53
  • 54. Oct/2008 rangsima@chiangmai.ac.th 54
  • 55. Snellen chart• Distance 6 m. or 20 ft.• Without glasses SC 6/24 , 6/36• with glasses CC 6/9 , 6/9• With pinholes CC PH 6/6 , 6/6• Interprete VA (visual acuity) numerator denotes the distance the patient is from the chart letter denominator denotes the distance from the chart at which normal person Oct/2008 rangsima@chiangmai.ac.th 55
  • 56. Visual acuity• 6/6, 6/9, 6/12, 6/18, 6/24, 6/36, 6/60• 5/60, 4/60, 3/60, 2/60, 1/60• FC 2 ft, FC 1 ft (finger count)• HM (hand motion)• PJ (projection of light)• PL (perception of light)• NLP (no light perception)Oct/2008 rangsima@chiangmai.ac.th 56
  • 57. VA with pinholes • Improve : R/O refractive error • No improve or worse : R/O Ocular diseaseSC 6/24 , 6/36 SC 6/12 , 6/9SC c PH 6/9 , 6/9 SC c PH 6/24 , 6/12Oct/2008 rangsima@chiangmai.ac.th 57
  • 58. VA Test in ChildrenOct/2008 rangsima@chiangmai.ac.th 58
  • 59. Oct/2008 rangsima@chiangmai.ac.th 59
  • 60. Contents  History Taking  Ocular Symptomatology  Visual Acuity Test  External Eye Examination  Eye Lids  Eyeball  Lacrimal System  Conjunctiva  Anterior Segment Examination  Cornea  Anterior Chamber  Iris  Pupil  Lens  Testing of Function of Extraocular Muscles Oct/2008 rangsima@chiangmai.ac.th 60
  • 61. • Torch light, Pen light• Magnifier Equipment• Eye pad• Cotton bud• Fluorescine strip• Direct Ophthalmoscope• Topical anesthesia Oct/2008 rangsima@chiangmai.ac.th 61
  • 62. Oct/2008 rangsima@chiangmai.ac.th 62
  • 63. External Eye • Orbit • Eyelid • Eyelash • Lacrimal system • ConjunctivaOct/2008 rangsima@chiangmai.ac.th 63
  • 64. AnatomyOct/2008 rangsima@chiangmai.ac.th 64
  • 65. Herpes Zoster Ophthalmicus Ecchymosis Cellulitis - Preseptal Cellulitis - Orbital Oct/2008 rangsima@chiangmai.ac.th 65
  • 66. Exophthalmos Enophthalmos Buphthalmos Lagophthalmos Oct/2008 rangsima@chiangmai.ac.th 66
  • 67. Trichiasis Distichiasis Poliosis Vogt Koyanagi Harada syndrome-Oct/2008 rangsima@chiangmai.ac.th 67
  • 68. Entropion Ectropion Molluscum Contagiosum Xanthelasma Carcinoma Oct/2008 rangsima@chiangmai.ac.th 68
  • 69. Dermatochalasis BlepharochalasisLevator dehiscence Ptosis Oct/2008 rangsima@chiangmai.ac.th 69
  • 70. Hordeolum Chalazion BlepharitisOct/2008 rangsima@chiangmai.ac.th 70
  • 71. Coloboma EpicanthusOct/2008 rangsima@chiangmai.ac.th 71
  • 72. Lacrimal System AnatomyOct/2008 rangsima@chiangmai.ac.th 72
  • 73. Oct/2008 rangsima@chiangmai.ac.th 73
  • 74. Dry Eye Syndrome Tear• Alacrima • Lacrimal Hypersecretion – Hereditary or congenital deficiency or absence of tear secretion. Oct/2008 rangsima@chiangmai.ac.th 74
  • 75. Oct/2008 rangsima@chiangmai.ac.th 75
  • 76. DacryocystitisOct/2008 rangsima@chiangmai.ac.th 76
  • 77. Conjunctival AnatomyOct/2008 rangsima@chiangmai.ac.th 77
  • 78. Oct/2008 rangsima@chiangmai.ac.th 78
  • 79. Oct/2008 rangsima@chiangmai.ac.th 79
  • 80. Oct/2008 rangsima@chiangmai.ac.th 80
  • 81. The Red Eye Conjuncival injection Red eyeCircumcorneal or ciliary injection Oct/2008 rangsima@chiangmai.ac.th 81
  • 82. Subconjunctival Hemorrhage Discharge Oct/2008 rangsima@chiangmai.ac.th 82
  • 83. Oct/2008 rangsima@chiangmai.ac.th 83
  • 84. Papilla & Follicle Papillary hypertrophy Cobble stone papillae Oct/2008 rangsima@chiangmai.ac.th 84
  • 85. Chemosis SymblepharonInflamed Pingueculum PterygiumOct/2008 rangsima@chiangmai.ac.th 85
  • 86. Betot spot PhlyctenulesOct/2008 rangsima@chiangmai.ac.th 86
  • 87. Oct/2008 rangsima@chiangmai.ac.th 87
  • 88. Oct/2008 rangsima@chiangmai.ac.th 88
  • 89. Oct/2008 rangsima@chiangmai.ac.th 89
  • 90. Foreign BodyOct/2008 rangsima@chiangmai.ac.th 90
  • 91. Contents  History Taking  Ocular Symptomatology  Visual Acuity Test  External Eye Examination  Eye Lids  Eyeball  Lacrimal System  Conjunctiva  Anterior Segment Examination  Cornea  Anterior Chamber  Iris  Pupil  Lens  Testing of Function of Extraocular MusclesOct/2008 rangsima@chiangmai.ac.th 91
  • 92. Oct/2008 rangsima@chiangmai.ac.th 92
  • 93. Anterior Segment AnatomyOct/2008 rangsima@chiangmai.ac.th 93
  • 94. Corneal AnatomyOct/2008 rangsima@chiangmai.ac.th 94
  • 95. Corneal light reflexOct/2008 rangsima@chiangmai.ac.th 95
  • 96. Megalocornea Arcus senilis Herbert’s pit Corneal Edema Oct/2008 rangsima@chiangmai.ac.th 96
  • 97. Cornea Haze Corneal Abrasion Oct/2008 rangsima@chiangmai.ac.th 97
  • 98. Dermoid cyst Rheumatoid Scleromalacia Perforans Corneal Ulcer Rheumatoid Oct/2008 Corneal Ulceration rangsima@chiangmai.ac.th 98
  • 99. Pannus Foreign BodyOct/2008 rangsima@chiangmai.ac.th 99
  • 100. Blinking reflex Slight Discomfort LacrimationOct/2008 rangsima@chiangmai.ac.th 100
  • 101. Oct/2008 rangsima@chiangmai.ac.th 101
  • 102. Anterior chamber Deep anterior chamber Shallow anterior chamberOct/2008 rangsima@chiangmai.ac.th 102
  • 103. Oct/2008 rangsima@chiangmai.ac.th 103
  • 104. Hyphema HypopyonOct/2008 rangsima@chiangmai.ac.th 104
  • 105. Coloboma PolycoriaIris Neovascularization Aniridia Oct/2008 rangsima@chiangmai.ac.th 105
  • 106. Iridodialysis Albinisms Iris prolapseOct/2008 rangsima@chiangmai.ac.th 106
  • 107. Pupil Pupil Round Equal React to light AccommodationOct/2008 rangsima@chiangmai.ac.th 107
  • 108. Anisocoria Polycoria and corectopia Oct/2008 rangsima@chiangmai.ac.th 108
  • 109. LeukocoriaOct/2008 rangsima@chiangmai.ac.th 109
  • 110. Pupillary Exam • Direct Light • Consensual Light • Swinging Flash LightOct/2008 rangsima@chiangmai.ac.th 110
  • 111. Oct/2008 rangsima@chiangmai.ac.th 111
  • 112. Relative Afferent Pupillary Defect - RAPDOct/2008 rangsima@chiangmai.ac.th 112
  • 113. RAPD- Relative Afferent Pupillary DefectOct/2008 rangsima@chiangmai.ac.th 113
  • 114. Oct/2008 rangsima@chiangmai.ac.th 114
  • 115. Oct/2008 rangsima@chiangmai.ac.th 115
  • 116. CataractsOct/2008 rangsima@chiangmai.ac.th 116
  • 117. Marfan’s Syndrome-Lens subluxationOct/2008 rangsima@chiangmai.ac.th 117
  • 118. Contents History Taking Ocular Symptomatology Visual Acuity Test External Eye Examination  Eye Lids  Eyeball  Lacrimal System  Conjunctiva Anterior Segment Examination  Cornea  Anterior Chamber  Iris  Pupil  Lens Testing of Function of Extraocular Muscles Oct/2008 rangsima@chiangmai.ac.th 118
  • 119. Oct/2008 rangsima@chiangmai.ac.th 119
  • 120. การตรวจการทางานของกล้ามเนื้อตา1.Ocular Motility 2.Corneal light reflex3.Cover test 4.Near point of convergence Oct/2008 rangsima@chiangmai.ac.th 120
  • 121. Six cardinal direction of gaze1.Ocular Motility การตรวจการกลอกตาข้างเดียว = duction Oct/2008 กลอกตาสองข้างพร้อมกัน = version rangsima@chiangmai.ac.th 121
  • 122. http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/surface/cardinal/cardinal.html Oct/2008 rangsima@chiangmai.ac.th 122
  • 123. 2.Corneal light reflex Hirschberg test• The white spots in each • The main light reflection is pupil are actually the in the same position in each reflection of the light from eye. Also note the extra light the penlight that is being reflections in both eyes that shined in the eyes. are due to the reflection of the ceiling light. Oct/2008 rangsima@chiangmai.ac.th 123
  • 124. • without glasses : left eye corneal light reflection is in the outer aspect of her left pupil, and the reflection in her right pupil is centered. • with glasses both eyes have a symmetrical reflection. • This illustrates the importance of keeping the child’s glasses on while administering this screening procedure.Oct/2008 rangsima@chiangmai.ac.th 124
  • 125. Oct/2008 rangsima@chiangmai.ac.th 125
  • 126. 3.Cover test –Alternate Cover Test –Cover Uncover Test Oct/2008 rangsima@chiangmai.ac.th 126
  • 127. Alternate Cover Test ู้ ่ให้ผป่วยจ้องไฟทีระยะห่าง 1 ฟุต ให้ผตรวจปิ ดตาผูป่วย สลับกัน ู้ ้ ทีละข้าง แล้วสังเกตดูการเคลื่อนทีของตาทีปิด ่ ่Oct/2008 rangsima@chiangmai.ac.th 127
  • 128. ถ้าตาไม่เคลื่อนที่ แสดงว่าตาตรง (orthophoric)ถ้าตาเคลื่อนทีแสดงว่าตาเข เช่น ่ ตาเคลื่อนที่จากด้านนอก เข้าหาตรงกลาง แสดงว่าตาเขนอก (exodeviation)ถ้าตาเคลื่อนทีจากด้านในเข้าหาตรงกลาง แสดงว่า ตาเขใน ่ (esodeviation) ถ้าตาเคลื่อนทีจากด้านบนเข้าหาตรงกลาง แสดงว่าตาเขขึ้นบน ่ (hyperdeviation)ถ้าตาเคลื่อนทีจากด้านล่างเข้าหาตรงกลาง แสดงว่าตาเขลงล่าง ่ (hypodeviation) Oct/2008 rangsima@chiangmai.ac.th 128
  • 129. Cover Uncover Test • หลังจากตรวจ alternate cover test แล้ว และพบว่ามี ตาเข และต้องการจะแยกว่าตาเขนันเป็ นชนิด ซ่อนเร้น (phoria) ้ หรือเปิ ดเผย (tropia) • ให้ผตรวจปิ ดตาข้างหนึ่งของผูป่วยแล้วเปิ ดออก และสังเกตการเคลื่อนที่ ู้ ้ ของตา • ถ้าผูป่วยนันทราบจากการตรวจ alternate cover test ้ ้ แล้วว่าเป็ นตาเขออกนอก เมื่อเปิ ดตาผูป่วยออกพบว่า ตาเคลื่อนจากด้าน ้ นอกเข้าหาตรงกลาง แสดงว่า ตาเขออกนอกนันเป็ นชนิดซ่อนเร้น ้ (exophoria) • แต่ถาตาไม่เคลื่อนที่ แต่ยงคงเขออกนอกอยูเ่ ช่นเดิม แสดงว่าตาเขออก ้ ั นอกนันเป็ นชนิดเปิ ดเผย (exotropia)Oct/2008 ้ rangsima@chiangmai.ac.th 129
  • 130. Oct/2008 rangsima@chiangmai.ac.th 130
  • 131. 4.Near point of convergence • ให้ผป่วยจ้องปลายวัตถุเล็ก ๆ ทีเ่ คลื่อนใกล้ ู้ เข้าหาผูป่วย โดยปกติตาสองข้างจะสามารถ ้ มองตาม วัตถุนนเมื่อเคลื่อนใกล้เข้ามา ใน ั้ ระยะ ห่าง 5-7 ซม. ถ้าไม่สามารถแสดงว่า เป็ น convergence insufficiency Oct/2008 rangsima@chiangmai.ac.th 131
  • 132.  History Taking Contents  Ocular Symptomatology  Visual Acuity Test  External Eye Examination  Eye Lids  Eyeball  Lacrimal System  Conjunctiva  Anterior Segment Examination  Cornea  Anterior Chamber  Iris  Pupil  Lens  Testing of Function of Extraocular MusclesOct/2008 rangsima@chiangmai.ac.th 132
  • 133. Any Question!!!! Rangsima Poomsawat http://www.facebook.com/RangsimaPoomsawat http://www.slideshare.net/rpoom http://www.youtube.com/RangsimaPoomsawathttp://www.facebook.com/pages/Nursing-Room-By-Rangsima/109937325743807?v=wall Oct/2008 rangsima@chiangmai.ac.th 133