Eye (Ophthalmic) Examination

• Greetings
• Hand wash
• Verify the patient's identity using at least two or three details
• Explanation
• Consent

Visual Acuity0/3

• Distance VisionUse 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.
• Near VisionUse Jaeger chart. Cover one eye, read paragraph of small print. Repeat for other eye. Use reading glasses if needed.
• Poor Vision AssessmentReduce distance to 3m or 1m. If still poor, assess counting fingers (CF@1m), then light perception.

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

Visual Fields and Blind Spot0/2

• Visual Fields TestUse hat pin or fingers at 1m distance. Assess each quadrant, patient to indicate when target first seen.
• (optional) Blind Spot AssessmentMove hat pin laterally and vertically, patient to indicate when red part disappears and reappears.

Eye Inspection and Pupillary Assessment0/6

• External InspectionCheck for ptosis, pupil size, symmetry, shape, colour, corneal haziness, fluid level.
• Pupillary Reflexes
  • Direct Pupillary Reflexlight in each eye ipsilateral constriction of each pupil
  • Consensual Pupillary Reflexlight in right eye and check left eye pupil constriction and vice versa
  • Swinging Light TestFor relative afferent pupillary defect
  • Accommodation ReflexFocus on distant object then finger 20-30cm in front

• Eye MovementsUse target 30cm in front, move through 'H pattern'. Check for nystagmus, extraocular muscle actions.
• Lid EversionFor 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.

Direct Ophthalmoscopy0/3

• PreparationAdjust lighting, patient to look at distant target, choose smaller less intense light, correct for self and patient.
  • Adjust LightingAdjust lighting, patient to look at distant target, choose smaller less intense light, correct for self and patient.
• Fundus ExaminationFind 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.

• Hand wash