How to Examine the Eye in Family Practice
Sarah Welch
GP CME 2014
Introduction
• Equipment and drops
• History
• Examination
• Management
Equipment
Drops
Tools for Management
History
• Change in Vision
• Ocular Discomfort
• Change in Ocular Appearance
• Trauma
Change in Vision
• Timing– Gradual– Sudden– Fluctuating
• Time of day – morning/ evening/ dark/light
• Disturbance– Central loss– Distortion– Field loss– Flashes/floaters– Haloes
Ocular Discomfort
• Aching
• Burning
• Foreign Body sensation
• Glare
• Headache
• Pain on eye movements
Uveitis
Uveitis
Acute Angle Closure Glaucoma
Change in Ocular Appearance
• Red Eye
• Lid malposition
• Shrinking Eye
• Swollen Lids
• Unequal pupils
• Prominent Eye
Red Eye
Red Eye
Ectropion
Ptosis
Chalazion
Enophthalmos
Proptosis
Examination
• Vision
• Anterior Segment
• Posterior Segment
• Pupils and Red Reflex
• Eye Movements
• Visual Fields
Visual Acuity
• Well lit chart
• With Glasses on
• Use occluder
• Use a pin hole
• Standardised Distance
• Charts are available on line – Near, colour, snellen
Visual Acuity Terminology
• NPL
• LP
• HM
• CF
• 6/60 – 6/6
• ph, gl
Corneal abrasion
Corneal Foreign Body
• Subconjunctival haemorrhage
– maybe slightly gritty/dry feeling
• Treatment:
– Lubricants
Painless Red Eye
Subconjunctival Haemorrhage
Large Subconjunctival Haemorrhage
Pingueculum
Pterygium
• Scratchy/Gritty
• Aching
• Deep headache, nausea, vomiting
Painful Red Eye
• Chronic symptoms
• Often have blurring of vision with reading
• Worse in wind / air conditioning / cold
• Treatment– Lots of lubricants
– Blepharitis lid care
• Manage not cure
Dry Eye/Blepharitis
Blepharitis
• Scales around base of lashes (collarettes)
• Chronic irritation worse in mornings
Blepharitis
• Shiny anterior lid margin • Greasy scales
• Lashes stuck together• Hyperaemia of lid margin
Posterior Segment
• Symptoms
– Flashes
– Floaters
– Change in Vision
• Red Reflex
• Vision
• Projection/fields
Amsler Grid
Pupils
• Response to light
• RAPD
• Red Reflex
• Symmetrical
RAPD – Relative Afferent Pupillary Defect
Eye Movements
• Squints
• Loss of Eye Movement
– Nerve palsies
– Restriction
• Nystagmus
• Force of Injury
• Hammering Metal on Metal
• Grinding
• Abrasion
Trauma
Complications of blunt trauma
Sphincter tear
Cataract Angle recession
Hyphaema
Lens subluxation
Iridodialysis Vossius ring
Rupture of globe
Complications of penetrating trauma
Flat anterior chamber
Vitreous haemorrhage
Damage to lens and iris
EndophthalmitisTractional retinal detachment
Uveal prolapse
Management of intraocular foreign bodies
Removal by pars plana vitrectomy
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