In the name of god Clinical eye examination

In the name of god Clinical eye examination Hamid Fesharaki MD Eye department Isfahan University of medical sciences History & physical examination

Clinical eye examination History & physical examination

Clinical eye examination History & physical examination Ophthalmic symptoms : pain, redness, itching, burning , F B sensation, Visual loss Snellen Chart Hand Held Acuity Card

Physical examination visual acuity: fixation & follow, snellen chart

Clinical examination Visual acuity: central, peripheral visual acuity is hard to check due to its subjective nature: depends on the response of the patient (intelligence , previous experience, alertness)

Measurment of visual acuity monocular vs binocular, wit or without correction far and near

Accurate clinical eye examination reduces the para clinical expensive testing Poor ophthalmoscopy may call for ocular sonography, OCT, FA… Define the best corrected visual acuity first Refraction is the beginning step of clinical examination clinical judgment without refraction can be miss guiding RAPD (Retrobulbar neuritis) Judgment by observation alone may be misleading A relatively pale optic disc Reduced light reflex of fovea Optometrist referral for retinal problem

Refractive error: retinoscopy, subjective refraction including the pin hole , autorefraction.

subjective refraction To find the best corrected visual acuity

Autorefrctor may give wrong numbers

Biomicroscopy

Direct ophthalmoscope

Observation of the fundus structures is very important for clinical diagnosis.

Visual loss: 1. Refractive error: retinoscopy, subjective refraction including the pin hole , autorefraction. (Irregular astigmatism) 2. Opacity of media: ophthalmoscopy, retinoscopy, biomicroscopy. (red reflex) 3. Retina & Optic nerve : ophthalmoscopic observation, RAPD, visual field, ERG, EOG, VEP, angiography, OCT, ultrasonography. (Amblyopia) Amblyopia: history & phsical: Anisometropia, Isoametropia, Strabismic, Deprivation (Monofixation synd) 4 prism base out test Malingering: age, gain, tricks Legal writing

Refractive error Irregular astigmatism

. Opacity of media: ophthalmoscopy, retinoscopy, biomicroscopy. ultrasonography (red reflex)

Evaluation of retina & optic nerve Visual field: Confrontation, tangent screen

Visual field: Static & kinetic perimetry

Visual field: Static & kinetic perimetry

Evaluation of retina & optic nerve • Observation: Compare between the two eyes, and compare with the population. • Correlate between BCVA, clarity of visual pathway and fundascopic findings • Relative afferent pupillary defect • Function tests: visual field, VEP, ERG, EOG. .

Retina & Optic nerve : Angiography, visual field, OCT, GDX, ERG, EOG, VEP, ultrasonography,

Beyond the optic nerve: Visual field brain imaging: MRI, CTscan

visual field

The pattern of visual field may be diagnostic

Snellen Chart For Acuity Testing

Checking Visual Fields By Confrontation

Left eye cannot move laterally

Observation External Structures Pupil, iris and eyelids & lashes should appear symmetric Sclera should be white Conjunctiva clear