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Physical Diagnosis > Ophthalmological Exam > Flashcards

Flashcards in Ophthalmological Exam Deck (12):

Refractive States

(list and define 5)

  1. Emmetropia: no refractive error
  2. Myopia: nearsightedness
  3. Hyperopia: farsightedness
  4. Presbyopia: decreased accommodation with aging
  5. Astigmatism: nonspherical cornea or lens; light rays not refracted uniformly


Components of Visual Exam


  1. Visual Acuity
    • Distance/near with correction
  2. Visual Fields
    • By confrontation
  3. Pupillary Examination
    • With hand-held light
  4. External exam
    • Orbit and 4 L’s
  5. Extraocular muscle evaluation
    • Motility, alignment
  6. Fundoscopy


Eye Inspection

(8 structures, describe what you're observing for)

  1. Position and alignment of eyes
  2. Eyebrows - quantity, distribution
  3. Eyelids
    • Width of palpebral fissures
    • Edema, color, lesions
    • Condition and direction of eyelashes
    • Adequacy of closed eyelids
  4. Lacrimal apparatus
    • Lacrimal gland and sac for swelling
  5. Conjunctiva and sclera
    • Color, vascular pattern
  6. Cornea and lens - opacities
  7. Iris – markings clearly defined
  8. Pupils – size, shape, symmetry, reaction to light (direct and consensual)


Visual Acuity Tests

(function, legal "failure")

Function: test integrity of macula, optic nerve, optic tract, and visual cortex

Legal Blindness: 20/200 BCVA


Visual Acuity Tests


  1. Have pt read the lowest line on Snellen chart with both eyes, then each eye separately 
  2. Record result as ratio
  3. Repeat test s glasses, if the pt wears them
  4. Have pt read the lowest line on a near vision pocket vision chart held 14 inches away from the face
  5. Record result as a ratio
  6. Repeat with/without glasses, if appropriate


Confrontation Visual Field Testing


Approximates large field defects in the four quadrants of each eye. (Bunny ears test)

Screening - Both eyes at same time; start in the temporal fields

Further testing - If a defect is found, test one eye at a time


Pupil Examination

(3 step procedure, 7 common abnormalities)


  1. Ask pt to fixate on distant target in dimly-lit room
  2. Shine pen light obliquely into one pupil twice; assess pupil size, shape, and symmetry of each eye
  3. Repeat shining light into the other eye

Note - obtaining direct and consentual eye results also checks the pupillary light reflex

Common Pathologies: The following conditions result in ansiocornia (assymetrical pupils)

  1.  Physiologic
  2. CN III palsy
  3. Horner's Syndrome
  4. Ocular trauma/inflammation
  5. Mydriatic eyedrops
  6. Recreational drugs
  7. Occular surgery


Accomodation Reflex

(2 step procedure)

  1. Ask patient to look into the distance and then at an object positioned 10 cm from the patient’s nose
  2. Observe normal pupil constriction and eye convergence


External Ocular Examination

(5 observations)

  • Inspect the orbits looking for exophthalmos (protruding eye) and enophthalmos (sunken eye)

Inspect the 4 “L’s”

  • Lymph Nodes - Preauricular, submandibular nodes
  • Lids - Ptosis, swelling, crusting, xanthelasma (lipid deposits), smooth opening and closure, entropion/ectropion (inversion/eversion)
  • Lashes - Direction and condition
  • Lacrimal Appartus - Tearing, obstruction, discharge, swelling


Extraocular Muscle Evaluation

(procedure, 7 common defects)

Assess motility: Instruct patient to follow an object in six cardinal positions of gaze; look for nystagmus and ask patient to diplopia in any position

Common Defects:

  1. Strabismus (congenital or late onset)
  2. CN palsy
  3. Graves' disease
  4. Myasthenia gravis
  5. Stroke
  6. Brain tumor
  7. Orbital tumor



(3 filters, significance of numbers)


  1. red-free (visualize blood vessels and hemorrhages)
  2. polarizing (reduce corneal reflection)
  3. cobalt blue (corneal abrasions upon fluorescein stain)


  1. red numbers, minus lenses for myopic eye
  2. green numbers = plus lenses for hyperopic eye


Opthalmoscope Procedure


  1. Darken the room and have the patient look off in the distance
  2. Switch the ophthalmoscope light and turn the lens disc to the large round beam of white light
  3. Turn lens disc to the 0 diopter
  4. Hold the ophthalmoscope in your right hand to examine the patient’s right eye with your right eye; hold it in your left hand to examine the patient’s left eye with Screening
    • Both eyes at same time; start in the temporal fields
  5. Further Testing - If a defect is found, test one eye at a time your left eye
  6. Stand directly in front of the patient, 15 inches away, and start at an angle of 15 degrees lateral to the patient’s line of vision
  7. Shine the beam of light onto the pupil and look for an orange glow; this is the red reflex
  8. Follow the red reflex and move inward towards the nasal aspect of the visual field