Ocular Examination & Investigation

DR. Sheriff Zaki

History & Case taking:

• Personal history: name; age; sex; residence; special habits

• Complaints: e.g. eye pain; headache; redness; defective vision

• Present history: onset; course; duration• Past history: eye operations; medication• Medical history: D.M.; hypertension• Family history: Myopia; squint; retinitis p.

Personal History:

• Name: to get acquainted with the patient• Age: certain diseases affect certain ages ex.

Primary open angle glaucoma > 50 years, PACG > 35 years

• Sex: certain diseases affect females ex. Primary angle closure glaucoma

• Job: certain jobs affect the eye ex. Cataract• Residence: certain areas contain environmental

factors that affect the eye

Complaint(s) of the patient:• Eye pain: it is either

1- Stitching pain corneal ulcer

2- Burning pain conjunctival inflammation

3- Dull aching pain iridocyclitis

4- Bursting pain acute congestive glaucoma• Headache:• Redness: Red eye syndrome• Defective vision:

Present History:• Onset: it is either 1- Sudden: ex. Sudden loss of vision CRA

occlusion 2- Rapid: ex. CRV occlusion rapid painless diminution of vision• Course: it is either 1- Progressive 2- Regressive 3- Stationary • Duration:

Ocular examination:

• External examination

• Anterior segment examination

• Posterior segment examination

• Testing visual acuity

• Measuring of intraocular pressure (IOP)

• Examination of the extraocular muscles

• Special ophthalmological examinations

External examination

• It is important to stand back and observe the patient's eyes:

1- Look at the eye lid symmetry and swellings

2- Are the eyes shrunken or protruding?

3- Is the conjunctiva red or not?

4- The upper eye lid must be everted to search

for a foreign body or examine the palpebral

conjunctiva

Testing visual acuity• Visual acuity for far vision is tested by:

- Landoll test [C pattern] - Snellen test [E pattern]

• Expressed by fraction :

numerator / denominator

= distance between chart & the patient /

smallest line seen at that distance

e.g. 6 / 6 ----- 6 / 60

If < 6 / 60 : 5 / 60 ----- 1 / 60

If < 1 / 60 : counting fingers, hand movements,

PL, no PL• Visual acuity for near vision : read charts

Anterior segment examination

• General examination in a good diffuse light

• Examination of focal (oblique) illumination using corneal loupe, binocular

• Examination of angle of A.C by gonioscope or the Gold-man 3-mirror test

Posterior segment (Fundus) examination• Direct ophthalmoscopy: (magnification 15 times) advantages: high magnification disadvantages: 1- mononuclear vision 2- Narrow field 3- Can not be used for surgery or examination of the peripheral fundus• Indirect ophthalmoscopy: (magnification 5 times) advantages: 1- Wide field 2- Binocular stereoscopic vision 3- Can be used for surgery & examination of the peripheral fundus• Fundoscopy (slit-lamp ophthalmoscopy):

Measurement of IOP

• Digital method

• Indentation tonometry (schoitz)

• Applanation tonometry (Gold-man)

• Non-contact (air) tonometry

Ocular Investigations:

• Ultrasonography

• Perimetry

• Fundus fluorescein angiography

• Electrophysiological studies

Ultrasonography:

1- Examination of post. Segment in opaque media

2- Detection of IOFB (site & nature)

3- Diagnosis of orbital diseases (Thyrotoxic

4- Measurement of axial length of the eye (A- scan)

Perimetry (Visual field testing)

(Gold-mann or automated peimetry)

• Diagnosis & follow up of glaucoma

• Diagnosis & follow up of optic n. diseases

• Diagnosis & follow up of retinal diseases

• Neuro-ophthalmological disorders

Fundus Fluorescein Angiography

• For diseases of retina & choroid:

1- Vascular occlusions (CRAO, CRVO)

2- Diabetic retinopathies

3- Macular diseases

4- Sub-retinal choroidal neovascularization

5- Retinal & choroidal neoplasms

Electro-physiological studies

(ERG, EOG, VEP)

• Diagnosis of hereditary retinal diseases

• Evaluation of potential retinal functions in eyes with opaque media

• Diagnosis of optic n. diseases

• Detection of malingering

.M.C.Q تجميعات• Uses of Gold-mann three mirror contact lens

1- Examination of fundus

2- Examination of the angle

3- Laser treatment of retinal diseases• Uses of slit-lamp:

1- Examination of A.C

2- Examination of P.C

3- With specific contact lens Fundoscopy

4- Measurement of IOP