Download Eye examination

Eye examination
이진희
• Function
– Vision
– Eye movement
• Anatomy
– Adnexa : Lids, periocular tissue
– Globe
– Orbit
Visual acuity
• V/S of ocular exam
• Testing central vision
– Distant visual acuity
• 6m => 3m
– Pocket near vision card
• 35cm
– Optokinetic nystagmus(OKN)
• Can’t communicate
• Factitious blindness or malingering
• Testing peripheral vision
Pupil
• Size, shape
• Reactivity to light
• Pupillary abnormalities
– Neurologic disease
– Acute intraocular inflammation  spasm or atony of the
pupillary sphincter
– Previous inflammation  adhesions of the iris
– Prior surgical alteration
– Systemic or eye medications
– Benign variations of normal
Extraocular movements
• Speed, smoothness, range
• Symmetry of movements
• Nystagmus
External examination
• General external examination of the ocular adnexa : eyelids,
periocular area
• Skin lesion, growth
• Inflammatory sign : swelling, erythema, warmth, tenderness
• The position of the eyelids : ptosis, lid retraction
• Gross malposition of the globe : proptosis(안구돌출)
• Palpation of the bony orbital rim & periorbital soft tissue
Slit lamp examination
Table mounted
Binocular microscope
With a special adjustable illumination source
• Anterior half of globe
(ant. segment)
– Lid margin, lashes
– Palpebral and bulbar
conjunctival surfaces
– The tear film and cornea,
iris
– Aqueous : abnormal cell
(red or white blood cell,
pigment granules),
turbidity (flare-protein↑)
– Anterior vitreous : dilated
pupil, crystalline lens
1st step
1. Overall screening
of the anterior segment
2. Beam to microscope : 45°angle
3. Beam : maximum height,
minimum width using the white light
4. Low power
Anterior chamber depth
2nd step
1. Identify any areas
of fluorescein staining
2. Beam to microscope : 45°angle
3. Blue filter / Fluorescein staining
4. Beam : width 3-4mm
• Fluorescein staining
– Dye that stains the
cornea
– Excessive amounts
of dye will absorb
into or collect within
the affected area
– Blue with a filtler
3rd step
1. Search for cells
in the anterior chamber
2. Beam : height 3-4mm,
as narrow as possible
3. High power
Tonometry
Schiotz tonometry
Tono-Pen XL
Goldmann applanation
tonometry
Direct ophthalmoscopy
Cup-to-disk ratio
Papilledema