Eye Exam

Eye Exam Procedure Overview

  • The eye exam includes repetitive elements from previous examinations (such as H, E, and T) but goes into detailed instructions on using instruments, particularly the ophthalmoscope.

Preparation Steps

  • Hand Hygiene: Wash hands before conducting the examination.

Eye Inspection

  • Initial Inspection:

    • Begin by observing the overall appearance of the patient's eyes from a distance.

    • Inspect the eyebrows:

    • Check for normal appearance.

    • Look for any flaking or loss of hair.

    • Examine the area under the eyes:

    • Assess for redness or swelling.

  • Inspect Eyelids:

    • Check eyelids for redness or swelling.

  • Conjunctiva Examination:

    • Ask the patient to look up while inspecting the conjunctiva:

    • It should appear white, not yellow, red, or blue.

    • Note conditions like osteogenesis imperfecta which may cause blue sclera.

Visual Acuity Testing

  • Distance Vision Testing:

    • Use a Snellen chart positioned 20 feet away.

    • Document patient's ability to read lines on the chart:

    • Record visual acuity for left eye, right eye, and both eyes.

    • Reference Snellen fractions to identify acuity levels (e.g., 20/30, 20/25, 20/20).

  • Near Vision Testing:

    • Use a card held at approximately 14 inches:

    • Cover one eye, then the other, then both.

    • Document results for near vision.

  • Ishihara Color Vision Test:

    • Use Ishihara plates to check for color blindness:

    • Ask the patient to identify numbers (e.g., 12, 5, 8, 3, 29, 15).

    • Note that blue-green color blindness is the most common.

Visual Fields Assessment

  • Confrontation Method:

    • Position yourself at the patient's eye level.

    • Ask the patient to cover one eye while you cover the opposite eye.

    • Wiggle fingers and ask the patient to report when they see movement:

    • Repeat for other eye.

    • Explore peripheral vision by moving fingers to other sides.

    • Note: Significant visual field defects may require further assessment.

  • Alternative Method:

    • Stand behind the patient and ask which direction fingers are wiggling while they look straight ahead.

Extraocular Movements Evaluation

  • Assessment Technique:

    • Instruct the patient to look straight ahead, using your finger on their chin to prevent head movement.

    • Conduct the H-pattern movement:

    • Move your finger to each corner and back, including up and down.

    • Ensure convergence is noted as the finger is brought to the center.

Pupillary Reflex Checking

  • Direct and Indirect Responses:

    • Utilize a light source to assess pupillary responses:

    • Position the light laterally, not directly into the eye.

    • Observe pupil constriction in the lighted eye (direct response) and opposite eye (indirect response).

    • Repeat for thorough examination.

  • Accommodation Assessment:

    • Instruct the patient to look at your finger and then at a distant object:

    • Observe constriction for near vision and dilation for distance vision.

    • Document with abbreviation PERRLA (Pupils Equal, Round, Reactive to Light and Accommodation).

Using the Ophthalmoscope

  • Setup and Configuration:

    • Switch light heads and ensure the focus wheel is set at zero diopters for initial setup.

    • Choose a large white light for examination.

  • Examination Technique:

    • The patient should remove glasses if worn.

    • Approach the eye at a 30-degree angle to avoid direct light to the macula.

  • Finding the Optic Disc:

    • Instruct the patient to focus on a distant object.

    • While illuminating and getting the red reflex, move into view gradually to observe retinal vessels and the optic disc:

    • Ensure proper support of their head to stabilize your position.

  • Repeat Examination:

    • Finish by examining both eyes, noting any differences or abnormalities.

Cover Test for Eye Deviation

  • Demonstration Procedure:

    • Instruct the patient to look straight ahead while covering one eye.

    • Observe any movements in the uncovered eye.

    • Switch sides and repeat:

    • A positive cover test reveals the weaker eye deviating when uncovered, confirming which eye has abnormal movement.

Conclusion of Exam

  • Final Remarks:

    • The examination concludes with appreciation of the patient's participation and the findings noted during the examination.

    • Importance of meticulous attention during each step is emphasized for accurate diagnosis and patient care.