Central visual acuity is the ability of the eye to see with

both eyes, by straight direction, on one point

Visometry is a method to assess central visual acuity,
which measures the eye's ability to discern fine details
at the center of the visual field.

V(visus)
distanceForo
=
 When
patient can't see first live in 5

meters
,
doctor should
get close to the
patient
by
I meter .
It will be continued until
the
patient will see line .

If patient can't see in Im :

in
counting fingers front
-virus of
the
face
the hand in
front of
-visus
moving
the face
in front
-using
the flash light of
the
eye--if patient can see light

&
correct light perception

if he can't see

incorrect
light perception
Light perception is the ability of the eye to detect the
presence of light. This is commonly tested in a darkened
room by shining a light toward the eye to see if the person
can perceive its presence.
 The Ishihara test is a color vision test for detection of red–green color de ciencies.
It was named after its designer, Shinobu Ishihara, a professor at the University of
Tokyo, who rst published his tests in 1917.

The test consists of a number of Ishihara plates, which are a type of

pseudoisochromatic plate. Each plate depicts a solid circle of colored dots
appearing randomized in color and size. Within the pattern are dots which
form a number or shape clearly visible to those with normal color vision, and
invisible, or dif cult to see, to those with a red–green color vision defect. Other
plates are intentionally designed to reveal numbers only to those with a red–
green color vision de ciency, and be invisible to those with normal red–green
color vision. The full test consists of 38 plates, but the existence of a severe
de ciency is usually apparent after only a few plates. There are also Ishihara
tests consisting of 10, 14 or 24 test plates, and plates in some versions ask
the viewer to trace a line rather than read a number.

Test procedure
Being a printed plate, the accuracy of the test depends on using the proper lighting
to illuminate the page. A "daylight" bulb illuminator is required to give the most
accurate results, of around 6000–7000 K temperature (ideal: 6500 K, Color
Rendering Index (CRI) >90), and is required for military color vision screening
policy. Fluorescent bulbs are often used in school testing, but the color of
uorescent bulbs and their CRI can vary widely. Fluorescent lighting showed better
results and faster recognition speed compared to CFL and LED luminance in
trichromats.[citation needed] Incandescent bulbs should not be used, as their low
temperature (yellow-color) gives highly inaccurate results, allowing some color
vision de cient persons to pass.

Proper testing technique is to give only three seconds per plate for an answer, and
not allow coaching, touching or tracing of the numbers by the subject. The test is
best given in random sequence, if possible, to reduce the effectiveness of prior
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memorization of the answers by subjects. Some pseudo-isochromatic plate books
have the pages in binders, so the plates may be rearranged periodically to give a
random order to the test.
Since its creation, the Ishihara Color Blindness Test has become commonly used
worldwide because of its easy use and high accuracy. In recent years, the Ishihara
test has become available online in addition to its original paper version.[7]
Though both media use the same plates, they require different methods for an
accurate diagnosis.

Rabkin’s polychromatic test

An album of 20 Pseudoisochromatic Plates rst published in 1936 in Russia. The

plates test for both red-green and blue-yellow defects and was the rst
Pseudoisochromatic Plate test to try and differentiate dichromacy from anomalous
trichromacy. The plates were well regarded, but were eventually beaten out by the
Ishihara plates and have not been commonly used since the 1950s (Hardy, Rand,
Rittler 1947). However, it is clear to see the in uence on the HRR Test
Pseudoisochromatic Plate test to try and differentiate dichromacy from anomalous
trichromacy. The plates were well regarded, but were eventually beaten out by the
Ishihara plates and have not been commonly used since the 1950s (Hardy, Rand,
Rittler 1947). However, it is clear to see the in uence on the HRR Test

The Ishihara test and Rabkin’s polychromatic test are both used to assess
color vision, but they differ in their approach and design.

Ishihara Test
• Format: Consists of a series of plates with colored dots forming numbers
or shapes.
• Purpose: Primarily designed to detect red-green color de ciencies.
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fl
fl
 • Method: Subjects identify numbers or patterns in the plates, which are
designed to be seen differently by individuals with color vision de ciencies.

Rabkin’s Polychromatic Test

• Format: Uses colored images and patterns that are typically more complex
and can include different hues.
• Purpose: Aims to assess a broader range of color vision de ciencies
beyond just red-green.
• Method: Subjects are asked to name colors or identify patterns, which may
involve distinguishing between more subtle differences in hue.

Summary

In essence, the Ishihara test is more focused on red-green de ciencies with

simple numerical patterns, while Rabkin’s test evaluates a wider spectrum of color
perception using more varied and complex designs.
↑

' Refraction is the ability of the eye to bend light as it

passes through its structures, such as the cornea and
lens, to focus images precisely on the retina.
Dioptic is the unit for refraction.

Types of refraction

clinic
Physical
static dynamic
Physical refraction describes the way light rays are bent as
they pass through the eye's structures to focus on the
retina. For normal physical refraction:
• the size of the eye - 24 mm
• shape-circular shape
• dioptic- 60 - 65 D (overall): cornea - 40D, aqueous
humour- 1D, lense- 18-23 D, glassy/vitruous body-1D
Static refraction is the measurement of the eye’s refractive
power in a relaxed, accommodative state, typically with no
active focusing on close objects.
• Examination Methods: The most common method to
measure static refraction is through retinoscopy or
objective refraction using an autorefractor. These tests
are done under cycloplegia (using eye drops to paralyze
accommodation) to ensure the eye is in a relaxed state.

Dynamic refraction assesses the refractive state of the eye

while it is actively accommodating, or focusing, on a near
object. It helps evaluate how well the eye can adjust focus
for varying distances.
Examination Methods: Dynamic retinoscopy or
accommodative testing is used to measure dynamic
refraction. These tests evaluate how the eye’s focus shifts
and are often done in a non-cycloplegic state.

Clinical refraction is the process of determining the correct

lenses required to correct refractive errors and provide
clear, comfortable vision.
Emmetropia is the ideal refractive condition of the eye,
where light rays entering the eye are perfectly focused on
the retina without the need for corrective lenses.
Ametropia refers to any refractive error where light does
not focus accurately on the retina, causing blurred vision.
It includes conditions where the eye’s shape or refractive
power is imperfect.

Types of Ametropia:
• Myopia (Nearsightedness): The eye is too long or the
cornea is too curved, causing light to focus in front of the
retina, making distant objects appear blurry.
• Hyperopia (Farsightedness): The eye is too short or
the cornea is too flat, causing light to focus behind the
retina, making close objects appear blurry.
• Astigmatism: Irregular curvature of the cornea or
lens causes light to focus at multiple points, leading to
blurred or distorted vision.
• Presbyopia: Age-related loss of the eye’s ability to
focus on near objects due to decreased flexibility of the
lens.
 Correction methods for myopia and hyperopia:
Glasses
Contact lenses
Surgery for cornea
Changing of the lense

Correction methods for astigmatism:

Glasses
Contact lenses
Surgery for cornea

Stages of clinical refraction:

1) first clinical stage - 1,25 - 3.0
2) second clinical stage 3,25 - 6.0
3) third clinical stage - 6,25 → higher

Blepharitis is a subacute or chronic inflammation of the lid

margins. It is an extremely common disease which can be
divided into following clinical types:
• Seborrhoeic or squamous blepharitis,
• Staphylococcal or ulcerative blepharitis,
• Scaly blepharitis
Seborrheic blepharitis :

Etiology. It is usually associated with seborrhoea of scalp

(dandruff). Some constitutional and metabolic factors play a part in
its etiology. In it, glands of Zeis secrete abnormal excessive neutral
lipids which are split by Corynebacterium acne into irritating free
fatty acids.
Signs. Accumulation of white dandruff-like scales are seen on the lid
margin, among the lashes. On removing these scales underlying
surface is found to be hyperaemic (no ulcers). The lashes fall out
easily but are usually replaced quickly without distortion.
Treatment of seborrhoic blepharitis
Local measures include removal of scales from the lid margin with
the help of lukewarm solution of 3 percent soda bicarb or baby
shampoo and frequent application of combined antibiotic and
steroid eye ointment at the lid margin.

Ulcerative Elepharitis :

Etiology. It is a chronic staphylococcal infection of the lid margin

usually caused by coagulase positive strains.

Symptoms. These include chronic irritation, itching, mild

lacrimation, gluing of cilia, and photophobia. The symptoms are
characteristically worse in the morning.
Signs. Yellow crusts are seen at the root of cilia which glue them
together. Small ulcers, which bleed easily, are seen on removing the
crusts. In between the crusts, the anterior lid margin may show
dilated blood vessels
 Treatment of ulerative Elepharitis :

Crusts should be removed after softening and hot compresses

with solution of 3 percent soda bicarb. Antibiotic ointment should
be applied at the lid margin, immediately after removal of crusts,
at least twice daily. Antibiotic eyedrops should be instilled 3-4
times in a day. Avoid rubbing of the eyes or fingering of the lids.
Oral antibiotics such as erythromycin or tetracyclines may be
useful. Oral anti-inflammatory drugs like ibuprofen help in
reducing the inflammation.

Scaly Elepharitis
causecommentdent
toskincomitina
leading to build scales the
up of
a on

eyelids.
Signs : characterized
by dry flaky scales
,

on the eyelid margins without the

greasy
quality found in seborrheic
Elepharitis
Symptoms
mild
patients may experience
:

redness irritation and ,

less
, flaking.
It is
generally severe than ulcerative
blepharitis .

Course :
often chrenic and can be
managed
with
good eyelid hygiene . It doesn't
usually cause
significant eyelash loss or
scarring
.
 EXTERNAL HORDEOLUM (STYE)
It is an acute suppurative inflammation of gland of the Zeis or
Moll.Inflammation
' of hair follicle)
Etiology
1. Predisposing factors. It is more common in children and young
adults (though no age is bar) and in patients with eye strain due
to muscle imbalance or refractive errors. Habitual rubbing of the
eyes or fingering of the lids and nose, chronic blepharitis and
diabetes mellitus are usually associated with recurrent styes.
Metabolic factors, chronic debility, excessive intake of
carbohydrates and alcohol also act as predisposing factors.
2. Causative organism commonly involved is Staphylococcus
aureus.
Symptoms
These include acute pain associated with swelling of lid, mild
watering and photophobia.
Signs
Stage of cellulitis is characterised by localised, hard, red, tender
swelling at the lid margin associated with marked oedema.
Stage of abscess formation is characterised by a visible pus point
on the lid margin in relation to the affected cilia.
Usually there is one stye, but occasionally, these may be multiple
Treatment
Hot compresses 2-3 times a
day are very useful in
cellulitis stage. When the pus
point is formed it may be
evacuated by epilating the
involved cilia. Surgical
incision is required rarely for
a large abscess. Antibiotic
eyedrops (3-4 times a day)
and eye ointment (at bed
time) should be applied to
control infection. Anti-
inflammatory and analgesics
relieve pain and reduce

Compresses
for first
the
are

stage
only
of
oedema. Systemic antibiotics
may be used for early control
of infection. In recurrent
inflammation of the styl. styes, try to find out and treat
the associated predisposing
condition.
CHALAZION
It is also called a tarsal or meibomian cyst. It is a chronic non-infective
granulomatous in ammation of the meibomian gland.
(there will
not be inflammation ,
and will be
without
pain)
Pathogenesis.Usually,first there occurs mild grade infection of the
meibomian gland by organisms of very low virulence. As a result,
there occurs proliferation of the epithelium and infiltration of the
walls of the ducts, which are blocked. Consequently, there occurs
retention of secretions (sebum) in the gland, causing its
enlargement. The pent-up secretions (fatty in nature) act like an
irritant and excite non-infective granulomatous inflammation of
the meibomian gland
Clinical picture
Patients usually present with a painless swelling in the lid and a
feeling of mild heaviness. Examination usually reveals small, firm
to hard, non-tender swelling present slightly away from the lid
margin. It usually points on the conjunctival side, as a red, purple
or grey area, seen on everting the lid. Rarely, the main bulk of the
swelling project on the skin side. Occasionally, it may present as a
reddish-grey nodule on the intermarginal strip (marginal
chalazion). Frequently, multiple chalazia may be seen involving
one or more eyelids.

Treatment
• Conservative
treatment.In a
small,soft and recent
chalazion, self-
resolution may be
helped by
conservative
treatment in the form
of hot fomentation,
topical antibiotic
eyedrops and oral
anti-inflammatory
drugs.
• Incision and drainage
fl