This document provides guidance for medical students on key aspects of eye exams and common eye conditions. It discusses evaluating visual acuity and visual fields, identifying pupil defects, testing for double vision, and examining the optic disc and retina for conditions like diabetic eye disease, cotton wool spots, and macular degeneration. Common eye problems covered include red eyes, gradual or sudden vision loss, eye trauma, and burns. Key tests and assessments are outlined, such as the swinging torch test to identify afferent pupil defects and checking for an intraocular foreign body after eye trauma. The document emphasizes the importance of thorough eye exams to identify any serious underlying issues.

1. Eye survival for Medical Students
• Peter Simcock FRCP FRCS FRCOphth

3. Big eyes and small eyes
• Big eye
• Myopia, Short sight
• Can see for near but blurred in distance without glasses
• Increased risk of retinal detachment
• Flashes and floater, shadow, one eye, hours or days
• Small eye
• Hypermetropia, Longsight
• Needs glasses for distance and stronger glasses for near
• In elderly increased risk of acute angle closure glaucoma

4. Normal retina

5. Vision = visual acuity and visual field
• Visual acuity – glasses and pinholes
• Visual fields – to confrontation
• Revision of anatomy of visual pathway from retina to occipital lobe

7. Pupils
• Unequal pupils – problem in motor or efferent pathway
• Swinging torch test – problem in sensory or afferent pathway
• Revision of anatomy of pupillary pathway to light from retina to pupil

10. Swinging torch test
• Very important test
• Swing torch repeatedly back and forth between
the two eye (2 seconds on each eye)
• An Afferent pupil defect is present when the
pupil of the illuminated eye gets larger instead of
constricting as normal

12. Double vision
• Are you worried?
• How do you test it?
• What must you exclude?

15. Diabetic eye disease

16. Cotton wool spots

17. Macular degeneration

18. Optic disc swelling

19. Check list for eye problems
• Test visual acuity
• Check visual fields to confrontation
• Check for afferent pupil defect
• Look at disc and check not swollen
• If all above OK will not be missing anything too serious!

20. Red eye/s, normal vision

21. Red eye, decreased vision

22. The red eye
• One red eye is something serious until proved
otherwise
• Serious problem if patients with ONE red eye
with blurred vision, pain or photophobia
• Never treat one red eye of unknown cause with
antibiotic drops

23. Abnormal appearance of eye or
eyelids
• Child with absent light reflex has cataract or
retinoblastoma until proven otherwise – urgent
assessment
• A child or adult with severely swollen red eyelids
on one side has orbital cellulitis until proven
otherwise – urgent assessment

24. Gradual visual loss

25. Sudden visual loss

26. Eye trauma
• A high-velocity foreign body has hit the eye, it is
IN the eye until proven otherwise
• Hammering metal on metal most at risk (less
commonly grinding metal)

27. FB hits the eye
• Exclude IOFB if high velocity
• Flip the lid

28. Burns to the eye
• Irrigate, irrigate, irrigate

29. Lid eversion

30. Resources
Eye Essentials for Every Doctor
Anthony Pane & Peter Simcock
Elsevier / Churchill Livingstone