Download Palpebral fissure

Eye examination
Dr Sajad Ahmad Salati
MBBS MS MRCS
Surface anatomy
Schematic diagram of cut-section
Eyebrow deformities
Hypothyroidism
Systemic lupus erythematosus
Lid edema
Eyelid lesions
Xanthelasma
Benign polyp
Epidermal cyst
Moluscum contagiousum
Skin tags
Stye
Skin cancer
Chalazion
Eyelash deformities
Madarosis
MADAROSIS : the abnormal loss of eyelashes
TRICHIASIS :In this condition the eyelashes are
reversed positioned, growing back to the ocular
globe
Eyelid deformities
PTOSIS
Ptosis is a drooping or falling of the upper eyelid
Ptosis
Exophthalmos
Exophthalmos is a bulging of the eye anteriorly out of the
orbit. Exophthalmos can be either bilateral (as is often seen
in Graves' disease) or unilateral (as is often seen in an orbital
tumor).
Exophthalmos
Rt Exophthalmos
Palpebral fissure
 The Palpebral fissure is the elliptic space between the medial
and lateral canthi of the two open lids.
 In simple terms, it refers to the opening between the eye lids. In
adults, this measures about 10mm vertically and 30mm
horizontally.
Abnormal palpebral fissure
Wide palpebral fissures
Examination of conjunctiva/sclera
The conjunctiva and sclera are examined with a penlight. The lower lid is pulled down
gently. The patient is asked to look up to examine the lower palpebral conjunctiva (lining
the posterior surface of the lids), the inferior cul-de-sac or fornix, and the inferior bulbar
conjunctiva (covering the eyeball itself).The patient is instructed to look down and the
upper lid elevated gently so that the superior bulbar conjunctiva may be observed.
Abnormal findings
Sclera and bulbar conjunctiva
•Yellow: Jaundice
•Blue sclera:
•Pterygium: Triangular thickening of conjunctiva growing across cornea.
•Pinguecula:Yellowish triangular nodule in the conjunctiva on either side of cornea
(Aging)
•Bitot's spots: Vitamin A def.
•Sub-conjunctival haemorrhage : Sharply demarcated red area , may involve the
entire conjunctiva (Cough, idiopathic)
Palpebral conjunctiva
•Pallor: Anemia
•Polycythemia: Suffused conjunctiva with tortuous full vessels
•Conjunctivitis: Red edematous with pus; diffuse dilatation of vessels maximal
peripherally
•Ciliary injection: Radiating vessels or reddish violet flush around limbus (Acute
iritis, acute glaucoma)
Jaundice
Pterygium
Blue sclera Ehlers Danlos Synd
Pinguecula
Pallor
Conjunctivitis
Conjunctivitis
Subconjunctival bleed
Conjunctivitis
Pupils





Pupil is the central aperture in the centre of iris.
Normal size : 3-4mm
Colour : Grayish black
Number : Normally one ( more than one is called polycoria)
Location : Normally almost central , slightly nasal . Eccentric is called
correctopia.
Normal
P Pupils
E Equal
R Reactive
L Light
Polycoria
Correctopia
Anisocoria
Anisocoria
is
a
condition
characterized by an unequal size of
the eyes' pupils. Affecting 20% of the
population, it can be an entirely
harmless condition or a symptom of
more serious medical problems.
Visual Acuity Test ( Snellen’s Test)
Using the foot as a unit of
measurement, (fractional) visual
acuity is expressed relative to 20/20.
Otherwise, using the metre, visual
acuity is expressed relative to 6/6.
The Visual Acuity Test represents
the smallest size that can be
reliably identified.
Interpretation of VA results
 VA of 20/20 means that a person can see detail from 20 feet
distance , the same as a person with normal eyesight would see
from the same distance.
 If a person has a visual acuity of 20/40, that person is said to
see detail from 20 feet the same as a person with normal
eyesight would see it , if 40 feet away.
 It is possible to have vision superior to 20/20: the maximum
acuity of the human eye without visual aids (such as binoculars)
is generally thought to be around 20/10 (6/3).
Testing poor vision:
•
•
•
If the patient is unable to read the largest letter
<(20/200)
Move the patient closer e.g. 5/200
If patient cannot read:
count fingers (CF)
hand motion (HM)
Light perception (LP)
No light perception (NLP)