Lecture4 subjective and objective eye exam

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Lecture4 subjective and objective eye exam

  1. 1. OBJECTIVE AND SUBJECTIVE EYE EXAMINATION Department of Ophthalmology Fatima Medical Center
  2. 2. SUBJECTIVE EXAMINATION <ul><li>Disturbance in vision </li></ul><ul><li>Ocular discomfort </li></ul><ul><li>Abnormal ocular appearnace </li></ul><ul><li>Abnormal ocular secretions </li></ul>
  3. 3. Time & manner of onset <ul><li>Chronic visual loss </li></ul><ul><li>Acute visual loss </li></ul>
  4. 4. UNILATERALITY & BILATERALITY <ul><li>Unilateral - e.g. trauma, vascular occlusion, secondary glaucoma </li></ul><ul><li>Bilateral- e.g. cataracts, age related macular degeneration (ARMD), diabetic retinopathy </li></ul>
  5. 5. SYMPTOMS <ul><li>Disturbance of vision </li></ul><ul><ul><li>Blurring of central vision </li></ul></ul><ul><ul><li>Decreased peripheral vision </li></ul></ul><ul><ul><li>Altered image size/shape </li></ul></ul><ul><ul><li>Diplopia </li></ul></ul><ul><ul><li>Flashes and floaters </li></ul></ul><ul><ul><li>Iridescent vision </li></ul></ul><ul><ul><li>Color vision problems </li></ul></ul><ul><ul><li>Dark adaptation problems </li></ul></ul>
  6. 6. <ul><li>Ocular pain or discomfort </li></ul><ul><ul><li>Foreign body sensation </li></ul></ul><ul><ul><li>Photophobia </li></ul></ul><ul><ul><li>Ciliary pain </li></ul></ul><ul><ul><li>Itching </li></ul></ul><ul><ul><li>asthenopia </li></ul></ul>
  7. 7. <ul><li>ABNORMAL SECRETIONS </li></ul><ul><ul><li>Lacrimation/epiphora </li></ul></ul><ul><ul><li>Discharge </li></ul></ul><ul><ul><li>Dryness </li></ul></ul>
  8. 8. ABNORMAL SIGNS <ul><li>Ptosis- drooping of the upper eyelid </li></ul><ul><li>Proptosis- outward protrusion of an eyeball </li></ul><ul><li>Enophthalmos- a “ sunken “ eyeball </li></ul><ul><li>Blepharitis- infection of lid margin </li></ul><ul><li>Strabismus- deviation of one or both eyes </li></ul><ul><li>Redness – extreme vascularity of conjunctiva </li></ul>
  9. 9. <ul><li>Opacity- disturbance of clarity </li></ul><ul><li>Masses- tumor lesions </li></ul>
  10. 10. Objective examination <ul><li>Visual acuity </li></ul><ul><li>External eye examination </li></ul><ul><li>Anterior segment examination </li></ul><ul><li>Pupils </li></ul><ul><li>Ophthalmoscopy </li></ul><ul><li>Occular motility </li></ul><ul><li>Tonometry </li></ul><ul><li>Visual field examination </li></ul>
  11. 12. Visual acuity <ul><li>Before anything else!! </li></ul><ul><ul><li>Baseline </li></ul></ul><ul><ul><li>Legal purposes </li></ul></ul><ul><li>Exception: </li></ul><ul><ul><li>Chemical burns </li></ul></ul><ul><ul><li>FLUSH!! </li></ul></ul>
  12. 13. Visual acuity <ul><li>Uncorrected distance </li></ul><ul><li>Corrected distance </li></ul><ul><li>Pinhole test </li></ul><ul><li>Near vision test </li></ul>
  13. 14. Snellen’s Chart
  14. 15. Visual acuity <ul><li>Distance acuity </li></ul><ul><ul><li>Snellen chart </li></ul></ul><ul><ul><li>Illiterate E </li></ul></ul><ul><ul><li>Notation eg. </li></ul></ul>
  15. 16. Visual acuity <ul><li>Distance acuity </li></ul><ul><ul><li>Snellen chart </li></ul></ul><ul><ul><li>20 feet or 6 meters away </li></ul></ul><ul><ul><li>Test one eye at a time </li></ul></ul><ul><ul><li>Use an occluder </li></ul></ul>
  16. 17. Jaeger Chart
  17. 18. External eye examination <ul><li>Ocular adnexae </li></ul><ul><li>Orbit </li></ul><ul><li>Conjunctiva </li></ul>
  18. 19. External Eye
  19. 20. Blepharitis
  20. 21. Entropion
  21. 22. Ectropion
  22. 23. Membranous Conjunctivitis
  23. 24. Follicular Hypertrophy
  24. 25. Papillary Reaction
  25. 26. Lid mass
  26. 27. ptosis
  27. 28. Lid Eversion
  28. 29. Anterior segment examination <ul><li>Cornea </li></ul><ul><li>Ant. Chamber </li></ul><ul><li>lens </li></ul>
  29. 31. Corneal Abrasion
  30. 32. Slit Lamp Examination
  31. 34. PUPILS <ul><li>Direct reflex </li></ul><ul><li>Consensual reflex </li></ul><ul><li>Normal pupil size 3-4mm under normal illumination </li></ul>
  32. 36. OPHTHALMOSCOPY <ul><li>Direct ophthalmoscopy </li></ul><ul><ul><li>Small field of view </li></ul></ul><ul><ul><li>Upright image </li></ul></ul><ul><ul><li>A large image size </li></ul></ul><ul><ul><li>No stereopsis </li></ul></ul>
  33. 38. <ul><li>Indirect ophthalmoscopy </li></ul><ul><ul><li>Large field of view </li></ul></ul><ul><ul><li>Inverted image </li></ul></ul><ul><ul><li>Small image size </li></ul></ul><ul><ul><li>Stereopsis( depth perception of 3-dimensionality) </li></ul></ul>
  34. 41. OPHTHALMOSCOPY <ul><li>STRUCTURES </li></ul><ul><ul><li>Optic nerve head- CD ratio of less than 0.3mm </li></ul></ul><ul><ul><li>Vessel caliber- AV ratio 2:3 </li></ul></ul><ul><ul><li>Retina </li></ul></ul><ul><ul><li>Macula </li></ul></ul>
  35. 44. OCCULAR MOTILITY <ul><li>6 Cardinal Positions of Gazes </li></ul><ul><li>Lateral rectus – (CN VI) </li></ul><ul><li>Sup. Oblique- ( CN IV) </li></ul><ul><li>the rest of the EOMs are innervated by CN III </li></ul>
  36. 46. Strabismus
  37. 47. TONOMETRY <ul><li>Normal IOP 10-22mmhg </li></ul><ul><li>Applanation tonometry </li></ul><ul><li>Schiotz tonometry </li></ul>
  38. 48. VISUAL FIELD EXAMINATION <ul><li>Confrontation test </li></ul><ul><li>Automated perimetry e.g. Octopus, Humphrey </li></ul>

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