Eye Examination & Opthalmoscopy
As with all the examinations, begin with the same opening sequence. Being friendly and rewording questions to make them sound less rehearsed will make your bedside manner appear much more natural and confident.
Introduction, Explanation, Consent
- Ask about pain, changes in eyesight
CNII - Visual acuity
- Using Snellen Chart
CNII - Visual fields
- Confrontational field testing
- Sit 1m away, face to face
- Ask patient to close one eye, you cover opposite eye
- Ask patient to look directly into your open eye
- Bring in finger from each of 4 quadrants, to tell you when they can see your finger
- Repeat for other eye
CNII - Visual inattention
- Patient with both eyes open, looking at your eyes
- Hold hands in two upper quadrants, move one finger, then simultaneous, ask patient to identify
- (Inattention if patient sees both when simultaenous, doesn't see when one is moved alone)
CNIII - Pupils
- Light reflex (direct and consensual)
CNIII, IV, VI - Eye movements
Explain to patient. Hold direct opthalmoscope vertically, - right hand to right eye, index on dial. Instruct patient to focus on distant object. Put scope to eye at a distance, see the subject's face.
- Elicit red reflex with opthalmoscope light from a distance of 1.5 feet
- For Right eye, place left hand on subject's forehead, thumb along eyebrow to raise it
- Start at arms length, 15/20 degrees lateral to line of gaze
- Move in as close as possible, use left hand to gauge distance.
- Start from zero lens power, look for any structure inside and focus accordingly
- Aiming for clear view of optic disk + blood vessels
- Continue to map entire disc
- Visual fields, diagnose type of defect, location
- Visual attention
- Disk color (orange-pink), disc margins (clearly defined), disc cup
- Disc flat or cupped. The pink rim delineates the rim (nerve fibers), the cup is white.