BASIC OPHTHALMOLOGY EXAMINATION

Dr. Budu, Sp.M, Ph.D

DEPARTMENT OF OPHTHALMOLOGY, FACULTY OF MEDICINE, HASANUDDIN UNIVERSITY

OPHTHALMOLOGY EXAMINATION

1. Routine :– Anamnesis– Physical examination– Visual function test

2. Special ocular examinations

Anatomy

ANAMNESIS

• Purpose: deep ocular evaluation• 2 methods :

– Autoanamnesis– Alloanamnesis

Collected infromations: 1. General : name, age, gender, address, jobs).2. Khusus :

a. Main complain : decrease of vision, diplopia, pain, etc.b. Other clinical symptoms link to main complain: onset, progressvity, duration, relaps, ocular movement disturbance, injury, glasses, or systemic diseases (DM, HT) etc

Physical examination

1. Inspection anterior segment of the eye

2. Obliq illumination anterior segment of the eye

3. Palpation finger tension

pain (uveitis)

mass

adenopathy

4. Intra ocular pressure

5. Visual fiield

6. Ophthalmoscopy

7. Visus

8. Refraction

1. Inspection

• No instrument• Point of inspection :

– Eyelids : supercilia, cilia, skin, fissura, plica, canthus, konjunctiva Right and left eyes ?

– Anterior segment :

1. Bulbus konjunctiva : injeksio konj.,

Inj.perikorneal, hiperemis, chemosis,

hemorrhagic, laseration, corpus alienum, etc

• Sclera : color, intact, thinness, tenderness, etc.• Cornea : clarity,diameter, curvature, intact, etc• Anterior chamber : content, deepness.• Iris : color, cripte.• Pupil : structure, position, color, margen,

numbers ?• Lens : clarity, position, posisi lensa (trauma)

On inspection, position and ocular movement were also evaluated

2. Obliq illumination

• Instruments : light.• Technique : illuminating light 450 from

medial and lateral. In dim light room.• Identified structure : more than inspection.

(Can be added with loupe + 1.00D- +5.00D)

Evaluated structures :1. Eyelids = inspection2. Anterior segments:

a. Cornea : Cikatriks nebula, CA, blood stainb. Iris : Cripte, sinechiac. Anterior chamber : contents (hifema,

hipopion)d. Pupil : light reflex (direct & indirect), pupil

margine. Lens : iris shadow & pseudo iris shadow

3. PalpationInstrument : no instrument .... Only finger.Purpose, to evaluate :

1. Tumor Mass 2. Preauricular gland enlargement

3. Pain (iridocyclitis/uveitis)4. Finger tension (TIO palpation)

Light can be used as tool in :• Hirschberg test (strabismus)• Light perception test (visus = 1/)• Light projection test (retinal function)

Tumor mass : consistency, pain, pulsation.

Preauricular gland enlargement palpate with end of finger :

- metastase/ cancer

- Ocular inspection ..... viral

Palpation for Intra ocular pressure :

1. Patient look at inferior

2. Two fingers in superior eyelids 1 cm from cilia.

3. One finger make palpation and the other endure eye ball undulation.

• Results :

Tn ………..TIO normal

Tn – 1 ……TIO hypotoni

Tn – 2 . …..TIO hypotoni ++

Tn + 1…….TIO high

Tn + 2…….TIO hugh ++

4. Intra Okuler pressure examination :Two methods :

1. With finger (paplation)

2. Instrument (Tonometer Schiotz) :

Tonometer SchiotzTechnique :1. Patient ..... supination2. Topical anasthesia instillation (R/ Pantocain 0,5%, 2%)3. Desinfection of tonometri schiotz.4. Ask patient to look at above. 5. Indent the tonometri to cornea of patient.6. Read tonometri scale

5. Visual field evaluation

To determine the vsual field margin.

Peripheral margin of field :Nasal/medial = 60 0

Temporal = 90 0

Superior = 70 0

Inferior = 50 0

Examination :1. Confrontation2. Amsler grid 3. Perimetri4. Tangent Screen (campimeter)

Amsler Grid

Perimetri

6. Funduscopy (posterior segment of eye ball

7. VISUAL ACUITY TEST

Visus (Visual Acuity): the ability to see objects in detail.

Classification : 1. Distance vision : 20 feet (5 metre)2. Intermediate vision3. Near vision : jarak baca (1/3 meter)

Distance vision := central visionInstrument : 1. Reading chart

a. Snellen chart b. E chart (E)c. Allen chart

2. Five (5) metre .... minimal3. Room illumination.

Fail in Snellen test, we used :

1. Counting Finger (CF) read value : 60

2. Hand movement/hand motion (HM) ;

read value= 300

3. Light perception (LP) ; read value =

Results : - numeral (5/40, 1/60, 1/300, dll)- decimal ( 1,0 ; 0,5 ; 0,1)

Pemeriksaan Khusus1. SLITLAMP BIOMIKROSKOP

2. EKSOFTALMOMETER HERTEL

3. USG MATA