This document provides an overview of procedures for examining the eyes in an outpatient department (OPD). It describes taking a patient history, assessing vision, performing a torch light examination, slit lamp evaluation, and fundus evaluation. Key areas examined include visual acuity, refraction, visual fields, eyelids and adnexa, pupil response, ocular motility, the anterior chamber, iris, lens, and intraocular pressure. Examination findings are used to identify common pathologies that may cause sudden or gradual vision loss or pain. A thorough eye exam evaluates both the anterior and posterior segments to screen for ocular diseases.

1. BASIC EXAMINATION OF
EYES IN OPD
Dr. Vaishali Rakheja
Senior Resident
Dr. R. P. Centre for Ophthalmic Sciences
AIIMS, New Delhi

2.  History taking
 Vision assessment
 Torch light examination
 Slit lamp evaluation
 Fundus evaluation

3. Leading Questions
 U/L or B/L
 Onset – Sudden/insidious
 Progression of complaints
 Painful/ painless
 Associated systemic history
Sudden and painless diminution of
vision
• Retinal detachments
• Retinal vein occlusions
• Vitreous hemorrhage
• Lens subluxation or dislocation
• Posterior uveitis
Sudden and painful diminution of
vision
• Acute anterior uveitis
• Keratitis
• Acute angle closure glaucoma
• Retrobulbar neuritis
• Endophthalmitis
• Traumatic lacerationsGradual, painless, progressive
diminution of vision
• Refractive errors, Presbyopia
• Cataract
• POAG, JOAG
• Corneal dystrophy
• Drug induced optic neuropathy
• Hereditary macular degenerations

4. EXAMINATION

5. Visual Acuity
 Spatial limits of visual
discrimination.
 Reciprocal of minimal angle
resolvable.

6. Visual Acuity
SNELLEN’S CHART
LogMAR CHART LANDOLT’S C-CHART

7. Refraction
 Objective refraction
1. AR
2. Retinoscopy
 Subjective refraction (assessing patient’s response)
 Cycloplegic refraction

8. Visual field assessment in OPD
Confrontation test
1. Each quadrant is tested monoocularly
2. Patient is made to count fingers or identify a light source
3. For the right eye of the patient – left hand of the examiner with
right eye occluded.
4. Interpretation: if the fingers/ light source identified
simultaneously- normal fields

10. Torch light examination
 General inspection
 Globe position
 Ocular motility
 Strabismus: Hirschberg’s test
 Pupil
 Eyelids and adnexa

11. General inspection
 Face- look for any asymmetry
 Extra-ocular features
 Scars suggestive of trauma or surgery

12. Globe
 Deep set globe
 Enophthalmos
 Proptosis, dystopia

13. Ocular motility
 6 cardinal gazes are tested
 Any limitation indicated with a
minus sign
 Overaction indicated with a
plus sign

14. Hirschberg’s test
 Malalignment of visual axis – strabismus
 The corneal reflex shifted opposite to the
direction of deviation
15 degrees- at the pupillary border
30 degrees- between pupillary border and
limbus
45 degrees- at the limbus

15. Pupil
 An aperture in the center of the iris
 Size of the pupil is determined by integrity of the
afferent and efferent pupillary pathways and the
tone of the sphincter and dilator pupillae muscles.
 Anisocoria- difference more than 0.5 mm.
 Polycoria- more than one pupillary openings.
 Corectopia- ectopic pupil
 Pupillary reflex – direct and consensual
 Relative afferent pupillary defect – Swinging Flash
light test

16. Swinging flash light test for
eliciting RAPD

17. Eyelids and adnexa
 The upper eyelid covers
approx. 2mm of the cornea
and the lower eyelid lies just
apposed to the lower limbus
 Ptosis
 Lid retraction
 Entropion and ectropion
 Eyelashes
 Lacrimal drainage system

19. Lacrimal drainage system

20. Slit lamp examination

21. Conjunctiva and sclera
 Anatomical divisions- Marginal, palpebral,
forniceal, bulbar
 Discoloration- melanosis
 Congestion- Diffuse, circumcorneal
 Papillae and follicles
 Degenerations like pterygium, pingecula,
and in vit A deficiency bitot spots in bulbar
conjunctiva
 Trauma- conjunctival lacerations,
subconjunctival hemorrhage

23. Cornea
 Size – microcornea(<10mm) ,
megalocornea (>13 mm)
 Shape – keratoconus, keratoglobus
 Opacities – nebular, macular,
leucomatous
 Neovascularisation – deep and
superficial
 Sensation
 Fluorescein staining – abrasion,
epithelial defects, ulceration
 Trauma- lacerations, foreign body

25. Anterior Chamber
 Depth- Van Herick
grading
 Contents- optically
clear/ flare
Aq cells
Aq pigments
 Hypopyon
 Hyphaema

26. Iris
 Color
 Pattern - atrophy
 Defects - coloboma

27. Lens
 Position
 Transparency

28. IOP
 Contact and non contact
procedure
 Applanation and indentation
tonometer
Gold standard- Goldman
applanation tonometry- but
contact procedures being
avoided- COVID-19

29. Fundus evaluation
 DDO
 Direct ophthalmoscopy
 Indirect ophthalmoscopy
 90 D slit lamp
biomicroscopy

31. Thank you