Basic Examination of the Eye Oie

7/23/2019 Basic Examination of the Eye Oie

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BASIC EXAMINATION OF THE EYE

ORI APRISIA PUTRI

I11108023



Eye examination requirement

Adequate light intensity Available tools and diagnostic drug

Systematic

Know anatomy physiology and pathology

Medical record



OphthalmicHistory

Past MedicalHistory: Vasculardisorderscommonlyassociated with

ocularmaniestationssuch as diabetesand hypertension

Past ocularhistori : reractivehistory! prior eye

inections orin"ury! medical

and#or surgicaltreatment

Medication : Manysystemicmedications may

have an e$ect onthe eye and on thepatient%s visualacuity and#orvisual &eld

'he chie complain: symptoms!

onset! duration!and cause o the

problem

A

Allergies#(rug)eactions:penicillin! contactdermatitis!chemical reactantsor ood orenvironmentalallergies

*amily Medical

History:strabismus!amblyopia!glaucoma! orcataracts! andretinal problems



Common Ocular Symptoms

Abnormalities o vision Abnormalities o ocular appearance

Abnormalities o ocular sensation pain anddiscomort



1. Abnormalities of vision

a+ Visual ,oss -ause by abnormalities Optical and

neurologic visual pathway reractive .ocusing/ error

lid ptosis clouding or intererence rom the ocular media

.eg! corneal edema! cataract! or hemorrhage inthe vitreous or aqueous space/

malunction o the retina .macula/! optic nerve! orintracranial visual pathway



b+ Visual Aberrations

Glare or haloes uncorrected reractive error! scratches!pupillary dilation! and ha0y ocular media .corneal edema orcataract/

Visual Distortion irregular pattern o dimness! wavy or "aggedlines! and image magni&cation or mini&cation .the aura o

migraine! optical distortion rom strong corrective lenses! orlesions involving the macula and optic nerve/

Flashing or fickering retinal traction or migrainousscintillations .a ew second or minutes/

Floating spots may represent normal vitreous strands due to

vitreous 1syneresis1 or separation Oscillopsia is a sha2ing &eld o vision due to ocular instability

Double vision is monocular or binocular .disappears i one eye iscovered/



2. Abnormalities of appearance

"red eye“

redness o the lids andperiocular area versus redness o the globe

The latter .subcon"unctival hemorrhage or byvascular congestion o the con"unctiva! sclera!

or episclera

e3ternal surace in4ammation -hanges in appearance o the globe

pterygium! and asymmetry o pupil si0e!called 1anisocoria5

'he lids and periocular tissues edema!redness! ocal growths! and lesions! andabnormal position or contour! such as ptosis



3. Pain & Discomfort Periocular pain tenderness o the lid! tear sac! sinuses! or

temporal artery

Retrobulbar pain all orbital in4ammations! nonspecic complaints such! as 1eyestrain!1 1pulling!1 1pressure!1 1ullness!1and certain 2inds o 1headaches!1 are poorly locali0ed+

Ocular pain -orneal epithelial damage or oreign body

sensation! -orneal epithelial damage typically produces asuper&cial sharp pain or oreign body sensation e3acerbated byblin2ing+

!ye rritation # Super&cial ocular discomort usually resultsrom surace abnormalities+ Symptoms :

6tching (ryness

'earing

secretions



Basic Ophtalmologic examination

'he purpose is to evaluate: *unction includes vision and nonvisual

unctions! such as eye movements andalignment

anatomy ocular problems can be subdividedinto three areas: those o the adne3a .lids andperiocular tissue/! the globe! and the orbit+



1. Refraction Test

An e$$etropic eye is naturally in optimal ocusor distance vision+

An a$etropic eye .myopia! hyperopia! or

astigmatism/ needs corrective lenses to be in

proper ocus or distance+

'his optical abnormality is called re%ractiveerror

Re%raction is the procedure by which any

reractive error is characteri0ed and quanti&ed )eraction is oten necessary to distinguish

between blurred vision caused by reractive error

or by medical abnormalities o the visual system





2. Testing Central Vision

Snellen chart1 iscomposed o a series oprogressively smallerrows o random lettersused to test distance

vision 7ach row is designated

by a numbercorresponding to the

distance! in eet ormeters! rom which anormal eye can read allthe letters o the row





Snellen -hart Picture 89eometricshape

'umbling7

,andolt)ing



-ounting &ngers : #;< = >#;< Hand movement : #?<<

,ight perception : #@

o light perception : total blindness



3. Pinhole Test

)eractive blurred.myopia! hyperopia!astigmatism/ multiple misocusedrays entering throughthe pupil andreaching the retina

Only a ew centrally

aligned ocused rayswill reach the retina!resulting in a sharperimage



4. The Confrontation Visual Field Test 'he patient is seated acing

the e3aminer with one eyecovered while the e3aminercloses the opposite eye

6n this way! the e3aminerBsnormal &eld o vision

corresponds to the patientBsand serves as the comparisonor the test+

'he e3aminer then presents to C &ngers in each o the C

quadrants o the visual &eldand as2s the patient to reportthe number o &ngers beingshown without loo2ingdirectly at them



Cornea Examination



Plasidiscope Test

Device: plasidiscope board withconcentric blac2 and white circle+

Techni&ue: Source o ,ight behind patient

Plasidoscope as high as eyes o patient See through space in the middle o

plasidoscope picture o patient cornea+

nterpretation# -oncentric shadow normal cornea

Oval concentric lines astigmatism

Dnregulated concentric lines irregulerastigmatism

Dnclear lines unclear cornea or

edema o cornea







Cornea Reflex / Cornea Sensibility

'i$# 'rigeminal nerve unction test+ Techni&ue# As2 patient to loo2 contrary side o e3amined

cornea+

Hold patient eyelid using thumb and inde3 &nger+ -otton patched to cornea surace

See present o patient cornea re4e3! pain! andlacrimation

'here is cornea re4e3

good sensibility -ornea re4e3 decrese to patient with 2eratitis!

herpes simple3 ulcer





Pupil examination



1. Pupil Examination 'he pupils should be

symmetric! and each oneshould be e3amined orsi0e! shape .circular orirregular/! and reactivity toboth light and

accommodation+ (irect response to light

reers to constriction o theilluminated pupil

'he consensualresponse is the normalsimultaneous constrictiono the oppositenonilluminated pupil



2. Extraocular Movements



Patient was as2ed to theirBs eyeball ollowingmovement o e3aminer &ngerBs



3. The cover tests () The cover*uncover test * to

detect the presence o% a s&uint# Observe i one eye is preerred or

&3ation

As2 the patient to loo2 at the &3ation

target = i in a child this can be a light ortoy

Occlude .or a ew seconds/ the eye thatappears to be &3ing+

As you cover the eye! watch the otheruncovered eye to see i it moves to ta2eup &3ation

)emove the occluder and see i the

original eye reta2es up &3ation+ 6 itdoes! it is the preerred &3ating eye and









Additional Slitlamp Techniques



1. Lid eversion

,id eversion toe3amine theundersurace o theupper lid can beperormed either atthe slitlamp orwithout the aid othat instrument+

6t should always bedone i the presenceo a oreign body issuspected



2. Fluorescein test Purpose 'o indentiy cornea

epithelium deect Sterile paper strips containing

4uorescein are wetted withsterile saline or localanesthetic and touchedagainst the inner surace othe lower lid! instilling theyellowish dye into the tear&lm

'he illuminating light o theslitlamp is made blue with a

&lter! causing the dye to4uorescein

A uniorm &lm o dye shouldcover the normal cornea+ 6the corneal surace isabnormal! e3cessive amountso dye will absorb into or





Measurement of IntraocularPressure



Palpation

Fith the patientBs eyes closed! the e3aminerplaces his or her hands on the patientBs headand palpates the eye through the upper eyelidwith both inde3 &ngers

The test is repeated on the contralateraleye %or co$parison)

A Groc2 hard5 eyeball only occurs in acuteangle closure glaucoma+

Slight increases in intraocular pressure suchas occur in chronic glaucoma will not bepalpable+





Tonometry

'onometry is the method o measuringintraocular pressure using calibratedinstruments

'he normal range is < to mm Hg



Applanation Tonometry

'he 9oldmann

applanation tonometeris attached to the

slitlamp and measures

the amount o orce

required to 4atten thecorneal ape3 by a

standard amount

'he higher the

intraocular pressure!the greater the orce

required



Schiotz Tonometry

'he advantage othis method is that itis simple! requiringonly a relativelyine3pensive! easilyportable handEheldinstrument



Gonioskopy 9onioscopy is the method o

e3amination o the anteriorchamber angle anatomy using

binocular magni&cation and aspecial goniolens)

Ater topical anesthesia! thepatient is seated at the slitlamp

and the goniolens is placed on theeye

Magni&ed details o the anteriorchamber angle are viewedstereoscopically+

Iy rotating the mirror! the entire

?;<Edegree circumerence o theangle can be e3amined+

'he same lens can be used todirect laser treatment toward theangle as therapy or glaucoma+



Direct Ophthalmoscopy

)ed )e4e3 73amination

6 the illuminating light is aligned directly along thevisual a3is! more obviously when the pupil is dilated!the pupillary aperture normally is &lled by a

homogeneous bright reddishEorange color+ 'his red refe+, equivalent to the 1red eye1 e$ect o

4ash photography! is ormed by re4ection o theilluminating light by the undus through the clearocular media

Any opacity located along the central optical pathwaywill bloc2 all or part o the red re4e3 and appear as adar2 spot or shadow+

6 the opacity is still moving or 4oating! it is located

within the vitreous .eg! small hemorrhage/+



*undus 73amination

'he primary value o the direct ophthalmoscope is ine3amination o the undus

evaluation o the central undus! including the dis2!the macula! and the pro3imal retinal vasculature+

Pharmacologically dilating the pupil greatly enhancesthe view and permits a more e3tensive e3amination othe peripheral retina+

6t is also optimi0ed by holding the ophthalmoscope as

close to the patient%s pupil as possible .appro3imatelyE inches/+ 'his requires using the e3aminer%s righteye and hand to e3amine the patient%s right eye andthe let eye and hand to e3amine the patient%s let eye



Device# otalmoscope and drug or dilatationo pupil .mydriacyl/+

Techni&ue# 73amine in dar2 roomJ

Prinsiple: right with right! let with let+ *irst! use +<< ( o optalmoscope+

Opthalmoscope is about < cm rom patient eye+

Move the opthalmoscope approach the eye and

change the lenticular orce approach < (+ ,ight ocus to the papil o optic nerve+

7valuate all part o retina







9. Indirect Ophthalmoscopy 'he indirect ophthalmoscope is worn on the

e3aminer%s head and allows binocular viewingthrough a set o lenses o &3ed power+

A bright ad"ustable light source attached to theheadband is directed toward the patient%s eye+

As with direct ophthalmoscopy! the patient is told toloo2 in the direction o the quadrant beinge3amined+

A conve3 lens is handEheld several inches rom the

patient%s eye in precise orientation so as tosimultaneously ocus light onto the retina and animage o the retina in midair between the patientand the e3aminer





Specialized OphthalmologicExamination



Perimetry

6s used to e3amine the central and peripheralvisual &elds+

'his technique! which is perormed separatelyor each eye! measures the combined unction

o the retina! the optic nerve! and theintracranial visual pathway+

6t is used clinically to detect or monitor &eldloss due to disease at any o these locations





Color Vision Testing (Ishihara Test) 'he plates are made up o

dots o the primary colorsprinted on a bac2groundmosaic o similar dots in aconusing variety osecondary colors

'he primary dots arearranged in simple patterns.numbers or geometricshapes/ that cannot berecogni0ed by patients with

de&cient color perception+ 'he patient should be given

a ma3imum o ? s toidentiy each plate+

6shihara plate



Diagnosis of Extraocular Abnormalities



1. Lacrimal System Evaluation

'ears and their components are produced bythe lacrimal gland and accessory glands in thelid and con"unctiva Schrimer 'est



'he Schrimer test is a simple method for assessing

gross tear production Schirmer strips are disposable 35-

mm-length dry strips of filter paper

The tip of one end is folded at the

preexisting notch so that it can

drape over the lower lid margin justlateral to the cornea

Tears in the conjunctival sac will

cause progressive wetting of the

paper strip

The distance between the leadingedge of wetness and the initial fold

can be measured after 5 minutes

using a millimeter ruler.



Interpretation

'he strip is then careully removed!and thelength o the strip that has become moistenedwith tears is measured+

A normal eye should produce enough tears to

wet at least < mm o the strip in > minutes



Schrimer Test 2

'his test do i in schrimer test be ound thatwet strip less than < mm ater > minute

+ On one o eye are droped topical anesthesiaand give schrirmer paper+

+ (o nose stimulation with cotton during minute

?+ 6n normal condition! &lter paper will wet>mm ater > minute+



2. Exophthalmometry A method is needed to

measure theanteroposterior location othe globe with respect tothe bony orbital rim

'he lateral orbital rim is a

discrete! easily palpablelandmar2 and is used as thereerence point

'he distance rom thecornea to the orbital rim

typically ranges rom to< mm! and the two eyemeasurements are normallywithin mm o each other



Abnormal protrusion o one or both eyes iscalled proptosis (or exophthalmos). Proptosisis caused by an increased mass in the orbitbehind the globe. Because the bony orbit isrigid, any increase in the volume of itscontents will push the globe forward.



3. Ultrasonography Dltrasonography utili0es the

principle o sonar to studystructures that may not bedirectly visible

6t can be used to evaluateeither the globe or the orbit

HighErequency sound wavesare emitted rom a specialtransmitter toward the targettissue

As the sound waves bouncebac2 o$ the various tissue

components! they arecollected by a receiver thatampli&es and displays themon an oscilloscope screen



OphthalmicRadiology(X-RayCTScan)



Ophthalmic Radiology (XRay, CT Scan)

Plain 3Erays and -' scans are useul in theevaluation o orbital and intracranial conditions+ -' scan in particular has becomethe most widely used method or locali0ingand characteri0ing structural disease in thee3traocular visual pathway+

'he intraocular applications o radiology areprimarily in the detection o oreign bodiesollowing trauma and the demonstration ointraocular calcium in tumors such asretinoblastoma+

MagneticResonanceImaging



Magnetic Resonance Imaging

'he technique o magnetic resonance imaging.M)6/ has many applications in orbital andintracranial diagnosis+

6mprovements such as surace receiver coilsand thin section techniques have improvedthe anatomic resolution in the eye and orbit+



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Basic Examination of the Eye Oie