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Ophthalmic Examination

This document outlines the components of an ophthalmic examination. It begins by defining an ophthalmic examination and listing its objectives. The main contents section describes the required materials, such as a slit lamp biomicroscope, and procedures for examining each part of the eye, including visual acuity, color vision, extraocular muscle function, the eyelids, conjunctiva, cornea, anterior chamber, iris, pupil, and lens. The conclusion emphasizes that an eye exam should be thorough and include relevant history, investigations, and a multi-systemic approach. Self-assessment and test questions are also provided.

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0% found this document useful (0 votes)

49 views24 pages

Ophthalmic Examination

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UBONGABASI EYO

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OPHTHALMIC

EXAMINATION
• DR. MEGBELAYIN EMMANUEL, MBBS (Ibadan), FMCOph, FVRS, FICS,
MPA, MSc(Ed.), PhD

• Dept., of Ophthalmology, Faculty of Clinical Sciences, University of Uyo.

• July 20, 2023.

Outline
❑Definition ❑Summary

❑Objectives ❑Assessment exercise

❑Main contents ❑Test questions

❑Conclusion ❑References/further reading

Definition
➢Ophthalmic examination comprises assessment of
the eyeballs, ocular adnexae, orbits and other parts
of the body suggested by history
▪Should be systematic and painstaking
▪Preceded by detailed and exploratory history
▪Proficiency is garnered from practice
Objectives
❖Itemize required materials for eye
examination

❖Explain key components of eye

examination
Main contents
➢Materials for ophthalmic examination

➢Procedures for ocular examination

Materials for eye examination
• Muscle light: illumination • Sterile saline
• Loupe: magnification • Tonometer
• Slitlamp biomicroscope: • Pachymeter
magnification
• Ultrasound Bio-Microscope
• Cotton bud (UBM)
• Ruler
• Ishihara chart • Contact lenses: goniolens, 3-
• Cotton wool: wisp, jones test mirror
• Medications: phenylephrine, • Exophthalmometer
tropicamide, tetracaine • Keratoscope
• Dyes: fluorescein, rose Bengal • Amsler grid chart
• Ophthalmoscope/retinoscope
• Non-contact lenses: 78D
• Lid retractor
Visual acuity
❖For distant
❖Unaided
❖With pinhole if less than 6/9
❖With glasses

❖For near
❖Rayners chart

• Blindness is Best Corrected Visual acuity (BCVA) <3/60 OR

Visual Field (VF) <100 from fixation in the better eye
Color vision testing
❖Ishihara chart
Examination of the head
❖Examination of head posture
❖ E.g Check for Head turn suggestive superior oblique muscle palsy

❖Examination of fore-head
❖ Fore-head wrinkling on looking up suggests Lower
Motor Neuron Lesion (LMNL) of 7th nerve palsy)
❖Eye brow examination
❖Madarosis. E.g. leprosy
Extraocular muscle function
• Range of action in the 6 cardinal positions of gaze
Eyebrow, Eyelid and Eye lashes:
•PENLIGHT
• scaling, or dandruff, poliosis, madarosis, tylosis,
trichiasis, pseudotrichiasis, ptosis, coloboma,
epicanthus, telecanthus, ectropion, entropion, lid
lag, lid retraction. Distichiasis, discharges,
lagophthalmos (facial nerve palsy, extreme
proptosis, symbleparon), ankyloblepharon,
Blepharophimosis
• lacrimal apparatus
• Lacrimal punctum: pouting, ectropion, atresia
Globe
❑Proptosis/exophthalmos (axial, non-axial): measure
with exophthalmometer
❑The eye ball could show any of these:
❑Anophthalmos, Microphthalmos, Anophthalmos, phthisis bulbi,
Bulphthalmos, unilateral high myopia
Conjunctiva
•palpebral, fornix, •Follicles, papillae can
bulbar be found
•Redness could be •Others are:
perilimbal, generalized Pingueculum,
or more toward the pterygium, squamous
fornices cell carcinoma
•Edema is called
chemosis
Cornea
▪Size: 11-12 mm
▪microcornea (D<10mm),
megalocornea(>13mm)
▪Shape: is convex
▪Abnormal shape:
keratoglobus,
keratoconus
▪ Decreased sensitivity in in:
Herpes simplex infection,
DM, leprosy
Anterior Chamber
➢Carried out with slitlamp and goniolens
➢Depth: Can be normal, deep, irregular, shallow
➢Causes of shallow AC: Primary Angle Closure Glaucoma,
hypermetropia, post-op wound leak,

➢Causes of deep AC: aphakia, myopia, posterior rupture globe

➢Content of AC: flare, cells, hypopyon, hyphaema, pseudohypopyon,
Iris
➢Colour: Heterochroma iridis seen in congenital
Horner’s syn,

➢Tremulousness call iridodonesis seen in aphakia

Pupil
➢Pupillary rnx: direct, consensual, swinging flash light test,
near reflex
➢Abnormal pupillary reactions: Relative Apparent Pupillary
Defect(Marcus Gunn pupil)
➢Shape: D-shape (iridodialysis)
➢Number: polycoria (iridectomy, iris atrophy)
➢Colour: greyish black (normal), jet black (aphakia), Leucocoria
(congenital cataract, Retinoblastoma, Retinopathy of
Prematurity, Hyperplastic Primary Vitreous, Toxocariasis)
Lens
❖Opacity
❖Dislocated
❖Subluxated
❖Intraocular lens
Ancillary examination
❖ Preauricular,
submandibular lymph nodes
❖Systemic examination including ENT and
dental
❖Arm span, height and weight
Summary
❑Anterior segment examination outline
❑VA
❑EOM
❑Brow
❑Lid
❑Lashes
❑Conjunctiva
❑Cornea
❑Anterior chamber
❑Iris
❑Pupil
❑lens
Conclusion
❖Eye examination should be guarded by detailed
exploratory history followed by investigations