Home       Objectives       Schedule       Lectures       Topics       Cases       Quizzes       PDA Refs     

Download for PDA

The Basic Eye Examination

for Medical Students

History – In addition to the usual components of history-taking, ask specifically about past history of eye disease or surgery, family history of eye disease, and current eye medications.

Visual Acuity – the “vital sign” of the eye exam.  ESSENTIAL!  Record in standard snellen notation (20/40, etc.), if possible, or count fingers, hand motion, light perception, or no light perception.  You are testing the entire visual system (not just refractive state), so always test with best correction in place.

Remember that “myopia” (near-sightedness–see well at near without correction) is corrected with “minus” lenses which minify; “hyperopia” (far-sightedness) is corrected with “plus” lenses which magnify; and “presbyopia,” the aging of the lens, usually from mid forties on, requires bifocals or reading glasses.

Pupils – key test of anterior visual pathway.  Check for anisocoria (different pupil sizes), reactivity, near response, relative afferent pupillary defect, as discussed in the neuro-ophthalmology lectures.

Visual fields – Snellen acuity measures central vision only.  Test peripheral vision for each eye separately, then simultaneously, by confrontation.

Motility and alignment – Assess for presence of a tropia (ocular misalignment) by having patient “fixate” (gaze upon) a small distant target while you cover, then uncover, each eye separately, looking for any eye movement.  Assess ocular movement (versions) in the six cardinal gaze positions.

External – Make a general inspection, looking for proptosis or enophthalmos, ptosis and other eyelid problems, especially at the lid margins.

Anterior segment – By penlight examine conjunctiva for hyperemia, edema, etc., check the smoothness of the corneal light reflex, and grossly inspect the anterior chamber and iris.  Evert the upper and lower lids to inspect the palpebral conjunctiva.

Intraocular pressure – can be assessed by Goldmann tonometry, Tonopen, Schiotz tonometry, or very grossly by palpation.

Dilated fundus examination – A good choice for dilation is phenylephrine 2.5%, a sympathomimetic drug with very few contraindications.  The risk of angle-closure glaucoma is very low.

Use your direct ophthalmoscope to inspect the red reflex (a good way to pick up corneal scars or foreign bodies, cataracts, or high refractive errors).  Examine the fundus by first locating and assessing the optic disc for color, margin clarity, and cupping, then proceed along the vascular arcades checking for silver wiring, plaques, etc., then assess adjacent retina for hemorrhages, cotton wool spots, etc, then last the macula and fovea.

                                                   Home       Objectives       Schedule       Lectures       Topics       Cases       Quizzes       PDA Refs     

                                              Last updated:  10/05/2002                                                          © 2000-2002 John Rose, MD  University of Utah School of Medicine