Eye (Ophthalmic) Examination

Use 3m/6m charts (Snellen, Tumbling E, or Animal chart for children). Assess with glasses. Use pinhole for poor vision. Record as 6/6 -2 for two letters incorrect, or previous line for three letters incorrect.

Use Jaeger chart. Cover one eye, read paragraph of small print. Repeat for other eye. Use reading glasses if needed.

Reduce distance to 3m or 1m. If still poor, assess counting fingers (CF@1m), then light perception.

Use Ishihara plates at 75cm distance, wear reading glasses if needed. Screens for red-green colour blindness.

Use hat pin or fingers at 1m distance. Assess each quadrant, patient to indicate when target first seen.

Move hat pin laterally and vertically, patient to indicate when red part disappears and reappears.

Check for ptosis, pupil size, symmetry, shape, colour, corneal haziness, fluid level.

Use target 30cm in front, move through 'H pattern'. Check for nystagmus, extraocular muscle actions.

For suspected foreign body. Evert lower and upper lids, sweep with moist cotton tip if necessary. Pull down the lower lid and have the patient look up. Press firmly about 0.5 cm below the lid margin. For the upper lid, ask the patient to tilt their chin up and look down. Place a cotton tip on the eyelid, grasp the eyelashes with your non-dominant hand, and gently pull down. With your dominant hand, rotate the lid around the crease and hold it everted. Sweep with a moist cotton tip, rolling it gently.

Adjust lighting, patient to look at distant target, choose smaller less intense light, correct for self and patient.

Find vessels, follow to optic disc, then to macula. Assess vessels for AV nipping, copper wiring, haemorrhages, cotton wool spots. Check optic nerve for crisp edges, haemorrhages, cup to disc ratio.