Basic of Ophthalmology Examinations

8/13/2019 Basic of Ophthalmology Examinations

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BASIC OF

OPHTHALMOLOGY

EXAMINATIONS



Ophthalmology examinations

1. General eye examinations :

– Anamnesis

– Physical of eye exam

– Visual function evaluation

2. Specific eye examinations



ANAMNESIS

• Purpose : to pursue the eye diseases

history

• two methods: : – Autoanamnesis (directly to the patients

Cooperative)

– Alloanamnesis (Family of the patients

non cooperative)



The collected informations : :

1. General : Identites (name, age, gender,address, job, and so on)

2. Specifics :

a. Chief of complain : blurred of vision,dyplopia, pain,irritatif, red eye, trauma

b. Other of clinical signs link to the maincomplain : onset, progressitivity, duration,

reversibility, lacrimation, disturbance of eyemotility, histrory of trauma, glasses, systemicdiseases (DM, HT), and so on



Physical of eye exam

1. Inspection anterior segment of eye ball

2. Oblique illumination anterior segment of eye ball

3. Palpation finger tension

pain pressure (uveitis)

Tumor mass

adenopathy (Preaurikuler gland)

4. Visus

5. Refraction

6. Intra ocular pressure

7. Visual field

8. Ophthalmoscopy



1. Inspection• No equipment

• Examiner directly observe the eye (good

illumination room)

• The evaluated structures : – Eyelid : supercilia, cilia, skin, fissura, plica, canthus,

conjunctiva (eyelid eversion) comparing the right

and left eyes

– Anterior segment of the eye :

1.Conjunctiva: injeksio, redness,chemosis,bleeding,

laseration, foreign bodies.







• Sclera : color, thickness, or trauma

• Cornea : diameter, curvature, intact (trauma).

• Anterior chamber : contents, deep or shallow.

• Iris : color, vasculature, crypte

• Pupil : Form, position, color, margin, number

• Lens : transparancy, position (trauma)

• Eye movements



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2. Oblique Illumination

• Equipments : pen light

• Technique ? :

• What are the visible structures : more detail thaninspection ?



Oblique illuminationsThe evaluated structures :

1. Eye lid : (= inspection)

2. Anterior segment : clearer the inspection

a. Cornea : cikatriks nebula, small foreign body,

blood stainb. Iris : kripte, sinekia

c. Anterior chamber : contents (hyphema,hypopion)

d. Pupil : direct/ indirect pupil reflex,regularitasity pupil margin

e. Lens : iris shadow & pseudo iris shadow





Myosis Mydriasis

Light reflex in the pupil



Anatomy

Physiology



3. PalpationNo equpments, only the finger

1. Tumor mass

2. Palpable of pre auriculer gland

3. Pain pressure (iridocyclitis/uveitis)

4. Finger tension (high of IOP)

Pen light evaluate : :

• Hirschberg test (strabismus)

• Light perception test (visus = 1/)

• Light projection test (retinal function)



Tumor mass : consistency, pain pressure,pulsation +.

Palpable of pre auriculer gland - Cancer spreading

- Viral infection of the eye



Palpation for IOP : Technique ?

CSL …………. Spesial sense system !



• Results : 5 category :

Tn ……….. Normal IOP

Tn – 1 …… Low of IOP

Tn – 2 . …..Very low of IOP

Tn + 1……. High of IOP

Tn + 2……. Very high of IOP



4. Intra ocular pressure evaluations

Direct & Indirect methods

Direct :

• Introducing canula to anterior chamber and

link to manmeter.• For animal study and experiment



Inderect : 2 methodes :

1. finger tension

2. Tonometer : contact and non contact.



Tonometri

Tonometer Schiotz

Tehnique : CSL of Special Sense system !









Hasil Pemeriksaan

Ditulis dalam bentuk 2 angka

• Angka pecahan (tanpa satuan) : sebagai

pembilang adalah skala dan beban sebagai penyebut.

• Angka desimal : dapat diperoleh pada

tabel yang ada pada tonometer dengancara menarik garis hayal horisontal.



5. Visual field (VF) testing

Purpose : to determine the peripheral visual field

Normal VF : Nasal/Medial field = 60 0

Temporal field = 90 0

Superior field = 70 0

Inferior field = 50 0



VF defects contribute to :

a. Diseases dignosis

b. Locations of lesions in retina, visualcortex area in the brain

Examination tests :

1. Confrontaion test (CSL special sense)

2. Amsler grid3. Perimetri (Goldman VF testing

4. Tangent Screen (campimeter)



7. Visual evaluations

Visual Acuity: the ability of the eye to percept the

detail and clear objects.Classification : based on reading distance :

1. Distance visual test : reading distance > 20

feet (5 meter)

2. Intermediate visual test

3. Near visual test : reading distance (1/3 meter)



Distance visual testing

Sinonim : Central visual testing

Equipments:1. Reading chart

a. Snellen chart (alphabet or numbering)

b. E chart (E)c. Allen chart (easy picture)

2. Reading distance 5 or 6 meter

3.Optimal room illumination

Technique ? CSL



Reading-object shifting :

1. Counting Finger (CF) ;

………reading value : 60

2. Hand movement/hand motion (HM) ;

……….reading value 300

3. Light perception (LP) ;

………..reading value (unlimited value)

4. No light perception : visus = 0



Visual testing results :

- 5/40, 1/60, 1/300 and so on- 1,0 ; 0,5 ; 0,1

Ex: VOD : 1/60 = Visual acuity of the right eye isthe ability of patient to only see object at 1 meter

while the normal individual can see in 60 meter.





8. Refraction test

• To indentify the refraction errors : Myopia,

Hyperopia, astigmatism

• Eq. : Snellen Chart & Trial Lenses

• Therapy : glasses, contact lens, LASIK



9 P t i t i ti ???



9. Posterior segment examinationa ???

Eq.: = Funduscopy/ ophthalmoscopy

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RETINA

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Ophthalmology scopes :

1. REFRACTION

2. LENS AND CATARACT

3. VITREO-RETINA

4. EXTERNAL EYE DISEASES (EED)5. TUMOR OF THE EYE

6. TRAUMA DAN RECONSTRUCTION

7. PEDIATRIC AND STRABISMUS

8. NEUROOPHTHALMOLOGY9. SOCIAL OPHTHALMOLOGI



EYE DISEASES SYMPTOMS

1. RED EYES

2. BLINDNESS

3. Abnormal Structures and positions

4. TRAUMA

5. Systemic and eye syndrome



RED EYE

•

RED EYE WITH IMPAIR/DECREASE OFVISUAL ACUITY

Ex. : Uveitis, Keratitis, acute glaucoma, trauma

• RED EYE WITH NORMAL VISUAL ACUITY

Ex. : conjunctivitis, Episcleritis, Pterygium



BLINDNESS

•SUDDEN BLINDNESS (SUDDEN VISUALLOSS)

Ex. : Retinal detachment, neuritis, vitreous bleeding

• CHRONIC VISUAL LOSS

Ex. : cataract, non acute glaucoma, retinitis pigmentosarefraction errors (=myopia, hyperopia, astigmatism)



Abnormal Structures and positions

• Eyelid : ptosis, ectropion, intropion dll.

•Eye ball : strabismus

• Structure : microphtalmia, keratoconus, bulls eye.

•

Proptosis: extra and intraokuler mass







TRAUMA

• PERFORANS TRAUMA

• NON- PERFORANS TRAUMA

(BLUNT TRAUMA)

• CHEMICAL TRAUMA (ACID OR

ALKALI

• FOREIGN BODIES OF THE EYE BALL





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Basic of Ophthalmology Examinations