Eye examination procedure for practical and theory exams

1. Presented to:
Resp. Kirti ma’am
Faculty
College of Nursing
VMMC & SJH
Presented by:
T.H Sasiine Linda
B.Sc (H) Nsg 4TH year
00450306618
EYE EXAMINATION

2. The Human Eye:
• Eye is an important and one of the most complex organ. It
helps in visualizing objects and also helps us in light, color
and depth perception.
• It is spherical in shape.
• It is about 2.5cm in diameter
• It is situated in orbital cavity.

3. EYE EXAMINATION:
• An eye examination is a series of tests
performed by an ophthalmologist ,
optometrist or orthoptist, opticians to assess
vision and ability to focus and discern objects
as well as other tests and examinations
pertaining to the eyes.

4. ASSESSMENT OF EYE DISORDERS
OCULAR HISTORY-
Questions asked during examination:
- What does the patient perceive to be problem?
- Is visual acuity diminished?
- Does patient experience blurred, double or distorted vision?
- Is there pain? Is it sharp or dull? Is it worse while blinking?
- Is the discomfort an itching sensation or more of a foreign
body sensation?
- Are both eyes affected?
- Is there any history of discharges? If so, enquire about colour
consistency and odour.

5. Contd.
• Describe the onset of problem(sudden or
gradual) Is it worsening?
• What is the duration of the problem?
• Is there any systemic diseases? What
medications are used for treatment?
• What makes the symptoms improve or
worsen?
• Is there any history of eye surgery?
• Does any other family members have the
same symptoms or condition.

6. VISUAL ACUITY
• VISIUAL ACUITY- .Visual acuity is tested for
both near 14 inches away and distance 20 feet
away Vision and is performed on each eye
separately with a standardized Snellen’s chart
for distance and a Rosenbaum pocket vision
screener for near vision.
• The fraction 20/20 or 6/6 is considered the
standard of normal vision

7. EXTERNAL EYE EXAMINATION
• The Nurse assess for symmetry and placement
of eyelids, pupils and muscles.
• The extraocular movements of the eyes are
tested by having the patient follow the
examiner‘s finger, pencil or a hand light
through the six cardinal directions of gaze
– Important when screening patients for Ocular
trauma or neurologic disorders such a myasthenia
gravis

8. Contd.
• The nurse observes for ptosis (drooping of the
eyelids) ectropion (turning out of lower
eyelid) entropion(turning in of eyelid) may
involve trichiasis (turning in of eyelashes).
Eyelids and eyelashes should be free of
drainage or scaling.
• The room should be darkened so that pupils
can be examined. The pupillary response is
checked with a penlight to determine if pupils
are equally reactive and regular.

10. DIAGNOSTIC EVALUATION
• DIRECT OPHTHALMOSCOPY- A direct ophthalmoscopy
is a handled instrument with various plus and minus
lenses
• The lenses can be rotated into place, enabling the
examiner to bring the cornea, lens and retina into focus
sequentially. The examiner holds the ophthalmoscope
in right hand and uses the right eye to examine
patient’s right eye. The examiner switches to the
patient left hand and left eye when examining patient’s
left eye.
• During the examination room should be on same level
as examiner eyes. The patient and examiner should be
comfortable and both should breath normally.

12. Contd.
INDIRECT OPHTHALMOSCOPY- it is used to see
large areas of retina although in a unmagnified
state. It produces a bright and intense light. The
light source is affixed with a pair of binocular
lenses mounted on the examiner’s head. The
ophthalmoscope is used with a handheld 20-
diopter lens.

13. SLIT LAMP EXAMINATION-
• It is a binocular microscope mounted on a table.
This instrument enables the user to examine eye
with magnification of 10-40 times real image. The
illumination can be varied from broad to narrow
beam of light for different view of eye.
• By varying width and intensity of light anterior
chamber can be examined for signs of
inflammation. These structures can be examined
eyelid, cornea, sclera, conjunctiva, iris aqueous
humor natural crystalline lens.

15. Contd.
• Once in the examination chair, physician will place
instrument in front of patient so as to rest chin and
forehead. This helps steady head for exam. Drops
containing yellow dye called Fluorescent are put in
eye which will wash away tear and make
abnormalities on surface of cornea more visible.
Additional drops may also be put in eyes to allow
pupils to dilate.

16. TONOMETRY
• It is a procedure to determine intraocular pressure( the
fluid pressure inside eye).It is an important test in
evaluation of patient’s at risk of glaucoma(Normal IOP=12-
22 mmHg).The device used for measuring IOP is an
accurately calibrated tonometer which measures the
pressure needed to flatter the cornea just a bit. Doctor will
adjust the tension until they get a proper reading. Because
the probe touches the highly sensitive cornea a topical
anaesthetic eye drops is administered prior to test
measurement.

17. COLOUR VISION TEST
• The most common color vision test is performed
using Ishihara polychromatic plates
• On each plate are dots of primary colors that are
integrated into a background of secondary colors
• Patients with diminished color vision may be unable
to identify the hidden shapes.

18. AMSLER GRID
• It is a test often used for patient with macular
problem such as macular degeneration. It consist of
geometric grid of identical squares with a central
fixation point. The grid should be viewed by the
patient wearing normal reading glasses. Each eyes is
tested separately. The patient is instructed to stare at
central fixation spot on the grid and report any
distortion in squares of grid itself.

19. FUNDUS PHOTOGRAPHY
• Fundus photography is used to detect and
document retinal lesions. The patient’s pupils
are usually widely dilated before procedure.
The resulting fundus photographs can be
viewed stereoscopically so that elevations
such as macular edema can be identified.

20. LASER SCANNING
• Various scanning techniques use laserlight in
diagnostic evaluation of eye disorders.
• confocal laser scanning ophthalmoscopy provides
a 3- dimensional image of optic nerve topography
and is used alone or in conjunction with fundus
photography to provide comparative data for
suspected optic nerve disease such as glaucoma
and papilledema (swelling of optic disc due to
increased intracranial pressure ICP)

21. ULTRASONOGRAPHY
• Ultrasonography is a valuable diagnostic
technique especially when the view of retina
is obscured by opaque media such as cataract
or hemorrhage. An ultrasonography B- scans
identifies pathology such as orbital tumors,
retinal detachment and vitreous hemorrhage.
• Ultrasonography A-scans are used to measure
axial length for implants prior to cataract
surgery.

23. ANGIOGRAPHY
• Angiography is done by using fluorescein or
indocyanine green and contrast agents.
• Fluorescein angiography is used to evaluate clinically
significant macular edema, document macular capillary
nonperfusion and identify retinal and chlorodal
neovascularization (growth of abnormal new blood
vessel).
• It is an invasive procedure in which fluorescein dye is
injected usually into an anticubital vein. Within retinal
vessels black and white photographs are taken by
retinal vasculature over a period of 10 mins.

24. Contd.
• Indocyanine green angiography is used to
evaluate abnormalities in the choroidal
vasculature, which often are seen in macular
degeneration.
• Indocyanine green dye is injected
Intravenously and multiple images captured
over a period of 30 secs to 20 minutes

26. SUMMARY
1. Introduction and Definition of Eye
2. Assessment of eye disorders:
– Ocular history, Visual acuity, external eye
examination
3. Diagnostic evaluation:
– opthalmoscopy, slit lamp examination,
tonometry, colour vision test, amsler grid, fundus
photography, laser scanning, ultrasonography and
angiography.