How to examine

1. BWALYA SALOME

3.  OUTER COAT(FIBROUS)
-Sclera
-Cornea
 MIDDLE COAT(VASCULAR)
-Choroid
-Cilliary body
-Iris
 INNER COAT(NEURAL)
- Retina
 VITREOUS HUMOR
 AQUEOUS HUMOR

4.  Anterior segment
-Inspection
-Palpation
-Intraocular tension
-Binocular loupe or slit-lamp examination
-Gonioscope examination
-Transillumination
 Posterior segment
1.) subjective examination
- visual acuity(for distance and near vision)
- field of vision(central or peripheral field)
- color vision
2.) objective examination
- electroretinography (ERG)
- electrooculograhy (EOG)

5. *INSPECTION
1. Head: position is characteristic in paralysis of extra ocular muscles.
2. Eyebrows: loss of hair or depigmentation(leprosy) or elevated due to
overaction in the frontalis muscle (ptosis).
3. Orbits: exophthalmos, enopthalmos
4. Eyeballs:-position and direction
-movements
-size and shape
5. Eyelids:-position
-palpebral aperture
-movement
-margins
-lashes
-glands
-lacrimal puncta

6. 6. Lacrimal sac: swelling and redness (mucocele)
7.Cornea:
- size: normal diameter is 11mm vertical and 12mm horizontal diameter.
- It is measured by a keratometer
- Curvature: normal radius is 7.8mm
- Surface by use of a keratoscope
- Transparency: opacities or ulcer
- Sensation: corneal reflex
- Thickness: on the periphery of the cornea it is 0.67 thick and 0.52mm in
the centre. It is measured using a pachymetre
NOTE: There are vital stains used to stain the cornea e.g fluoroscein,
Bengal rose 1% and alcian blue
8.Sclera: curvature, vessels and color

7. 9. Conjunctiva
i. Bulbar: conjuctival and cilliary congestion
ii. Palpebral: congestion as in conjunctivitis, scaring e.g trachoma and
membrane.
iii. Plica semilunaris: it maybe displaced
iv. Caruncle: there maybe inflammation

8. 10.Anterior chamber
i. Depth: shallow, deep or irregular.
ii. Content:-cloudy
-pus
-blood
-lens matter
foreign body
11.Iris
 Color
-heterochromia iridium: the two irides are of different color
-heterochromia iridis: parts of the same iris are of different color.
-muddy
-white atrophic patches
 Pattern: loss of pattern (chronic iridocyclitis)
 Position:- anterior synechia: adhesion of the iris to the surface of
cornea
-posterior synechia: adhesion of the iris to the lens capsule.

9. 12. PUPIL
 size: normal size is 2-4mm
-anisocoria: unequal size of both the pupil
 Shape
-central and secular
-irregular(posterior synechia)
 Pupillary reflex
-accommodation reflex: the pupil constricts at near objects.
-psycho-sensory reflex: the pupil will dilate on psychic or sensory stimuli.
13. LENS
 Color
-normal color is jet-black
-Grey : immature cataract
-white: mature cataract
 Opacity
 Position: the lens may dislocate when there is complete rupture of the
zonule following trauma

10. *PALPAPTION
 Orbit: irregular margin, swelling or tenderness
 Digital tension: palpate through the upper lid. The tension is estimated
by the amount of fluctuation.
 Lymph nodes: palpate the periauricular lympnodes.
*INTRAOCULAR PRESSURE
 Normal intraocular pressure is 10-20mmHg
 Measured using a tonometre.
*BINOCULAR LOUPE AND SLIT LUMP
 Binocular loupe: used to assess the depth of opacities ( magnification3-4
times)
 Slit lump: used to exam the structures of the eye e.g retina, cornea or
iris for any abnormalities.

11. SLIT-LUMP BINOCULAR-LOUPE

12. *GONIOSCOPE EXAMINATION: it is used to identify abnormal angle
structures e.g anterior synechiae, tumor, foreign body or used to
estimate the width of the angle of the anterior chamber as in closed
angle gaucoma.
Normal angle structures: schwalbe’s line, trabecular meshwork,
scleral spur and cilliary band.

14. *TRANSILLUMINATION.
 Trans-scleral : when light is introduced through the sclera, the
pupil appears red in color but if there is a solid mass in the path
of light, the pupil remains black e.g intra ocular tumor.
 Trans- Pupillary : when light is allowed to pass obliquely through
dilated pupil, the pupil becomes illuminated uniformly in the
normal cases.

15. 1.SUBJECTIVE EXAMINATION OF RETINAL FUNCTIONS.
*Visual acuity
 It is the measure of smallest retinal image which can be
appreciated.
 It measures the ability of the eye to distinguish shapes and
the distance of object at a given distance.
 It is assessed using the senellen’s chart. This chart consists of
a series of letters arranged in lines each diminishing in size.
 The lines from above downwards should be read at
60,36.24,18,12,9,6,5.

16. *Recording of visual acuity for distance
 The normal visual acuity is=6/6
 When the pt can only read the 18m line, his distance vision
is defective=6/18.
 when the patient can not read the largest letter, he is
asked to slowly move towards the chart. If he can read the
top most letter at 5,4,3,2m his visual acuity
=5/60,4/60,3/60,2/60 respectively.
 If the pt is unable ton see the top letter when close to it,
ask the pt to count the examiner’s fingers held at 1m
against a dark background, if he can count the fingers, the
VA is=1/60
 If pt can count fingers only at 50cm, VA= counting fingers
at 50cm.
 If he can not count fingers, the examiner’s hand is moved
in front of the eyes close to the face. If he can appreciate
the movements, VA=hand movements

17.  In a dark room, light is concentrated on the pts eyes, the ask the
pt to say when the light is on his eyes or when it is off, if he tells
correctly, VA=PL(perception of light).
 If he gives correct indication of the direction from where the
light is coming from then VA=PL and projection of rays is good.
 If he fails to see the light, he is blind.VA= no PL(no perception of
light)

18. *Recording visual acuity for near
 The pt reads snellen’s test type for reading (N series) at a
distance of about 25cm with good illumination.
 The normal vision is recorded as N/6.

19. Simple picture chart

20. E chart Landolt’s chart

22. * The fields of vision.
 The visual field is a three-dimensional area of the
subject’s surrounding that can be seen at any one time
around an object of fixation. it also refers to how far
peripherally you are able to see without moving your eyes
or head.
 The normal visual field is 60 superiorly, 60 inwards,70
inferiorly and >90 outwards.
 Blind spot : this is an area of absolute scotoma(no-seeing
area) within the boundaries of normal vision
 Perimertry: the term used to describe various techniques
employed to evaluate both peripheral and central visual
fields using targets of various sizes and colors.

23. Confrontation method: the pts field of vision is compared
with that of the examiner having a normal field of vision.

24. the examiner fixes a spot in the centre of the screen
A small white disc attached to a long rod in front from the
periphery towards the fixation point until the pt recognizes
the target.

25. *Color of vision.
the main objective of testing color vision:
 To find out the exact nature of the defect e.g red or green color
blindness.
 whether the patient is likely to be a sour of danger to the
society e.g driver or pilot.

26. 2. Objective examination of retinal functions.
 Electroretinogram (ERG) : measures the electrical activity of the
retina in response to a light stimulus. The activity is absent in
complete failure of rods and cones e.g complete retinal
detachment.
 Electro- oculogram (EOG): it measures the resting potential of
the eye which exists between the cornea and back of the eye.