Anamnese and Examinating Eye

By: Sayed Hamzah

ANAMNESE Main complaint Red eye, decreased visual acuity Red eyes, good vision Calm eyes, sudden decreased vision Calm eye, visual acuity decreased slowly

History of present illness / first (duration, frequency, intermittency, and rapidity of onset, location, the severity)

Eye medication used Systemic - Disease? Surgery?                            - Systemic Drugs in use history of allergic family history

Physical Examination

• Ocular history : Chief complaint, past medical history, family history• External examination• Visual acuity• Visual Fields• Fundoscopic Examination

Ocular history Chief complaint: duration, frequency, intermittency, and

rapidity of onset. Past medical history: general state of health and principal

systemic illnesses. family history is pertinent for ocular disorders, such as

strabismus, amblyopia, glaucoma, or cataracts, and retinal problems, such as retinal detachment or macular degeneration. Medical diseases such as diabetes may be relevant as well.

External Inspection

Inspect the lids, surrounding tissues, and palpebral fissure. Palpation of the orbital rim and lids may be indicated, depending on the history and symptoms.

Inspection of the conjunctiva and sclera is facilitated by using a penlight and having the patient look up while the examiner retracts the lower lid or look down while the examiner raises the upper lid.

Upper lid eversion The patient is asked to look down

and the examiner grasps the eyelashes of the upper lid between the thumb and the index finger. A cotton-tipped applicator is used to press gently downward over the superior aspect of the tarsal plate as the lid margin is pulled upward by the lashes.

Bulbar conjunctiva

Alignment examination

Cornea Placido test Fistel test

TES FLUORESCEIN

Anterior Chamber Steps to assess anterior

chamber depth:1. Shine a light from the

temporal side of the head across the front of the eye parallel to the plane of the iris

2. Look at the nasal aspect of the iris. If two thirds or more of the nasal iris is in shadow, the chamber is probably shallow and the angle narrow

Pupillary examination

Pupil size Observe reflection of pen light in both pupils. Is it symmetrical? Test the papillary response to lightDirect response – pupil constricts in examined eyeConsensual (Indirect) response – pupil constricts in the opposite eye

Swinging Flashlight Test

•A bright light is placed in front of one eye and moved quickly to the other eye, then one or two seconds later moved quickly back to the first eye.•The pupils should remain constricted when the light is taken from one eye quickly to the other

Visual acuity

Snellen Chart (Normal visual acuity is 5/5 (20/20) Counting fingers Hand movement Light perception

Snellen Chart

If pt. wears glasses and are not available use pinhole testing.

If patient cannot read, then document number of fingers held up.

Hand motion at 2 ft. If fails hand motion,

document light perception

Visual fields• Ask the pt to cover one eye• Cover your opposite eye• Ask the pt to look straight

ahead• Place one hand in the plane

between the patient and the examiner out of your vision

• Move the hand and ask the patient when he/she can see your hand

Confrontation test

Ocular movementsSix Cardinal Positions of Gaze

Fundoscopic Examination • Darken the room• Use R hand for pt’s R eye and L hand

for pt’s L eye• Ask pt to fix gaze on a spot on the

wall• From about 15” away and about 15o

lateral look into pt’s eye• Observe the red reflex and then

move in closer• You may rest your opposite hand on

the pt’s forehead above the eye to help guide

• Move the opthalmoscope very close to the pt’s eye

• If you initially see blood vessels, you can follow the blood vessels toward the disc.

• They flow like rivers toward the disc.• Diopters may need to be adjusted to obtain a good

focus

• Once you see the disc, you should note its color and note what percent of the physiologic cup involves the disc.

• The cup-to-disc ratio should be less than 0.6.

• You should note the size of the arterioles as compared to the veins. They should be 2/3 to 4/5 the size of veins.

• Next look in all 4 quadrants of the retina• Finally, look at the fovea and macula.

This may be accomplished by asking the pt to look at the light

Other examinations

Perimetry/campimetry Tonometry Exophthalmometry Anel test Schrimer test Color vision

Campimeter

Digital palpation

Schiotz Tonometer

Anel Test

Hertel Exophthalmolmeter

Schirmer test

Color vision tests (Ishihara)

Thank You