Snellen chart or Lea cards, Landolt C or HOTV chart

image Eye cover, gauze, or opaque card

image Rosenbaum or Jaeger near-vision card

image Penlight

image Cotton wisp

image Ophthalmoscope



Ask patient to sit or stand.

Measure visual acuity in each eye separately

image Distance vision

Use Snellen chart, Landolt C or HOTV chart. If testing with and without corrective lenses, test without lenses first and record readings separately.

EXPECTED:Vision 20/20 with or without lenses with near and far vision in each eye.
UNEXPECTED:Myopia, amblyopia, or presbyopia.

image Near vision

Use near-vision card.

EXPECTED:Vision 20/20.
UNEXPECTED:Fields of vision more limited than temporally, 50 degrees superiorly, 70 degrees inferiorly.
imagePeripheral vision
Test nasal, temporal, superior, inferior fields by moving your finger into field from outside.
Inspect eyebrows
imageSize/extension EXPECTED:Unusually thin if plucked.
UNEXPECTED:End short of temporal canthus.
imageHair texture UNEXPECTED:Coarse.
Inspect orbital area
  UNEXPECTED:Edema, puffiness not related to aging, or sagging tissue below orbit. Xanthelasma.
Inspect eyelids
imageEyelid position UNEXPECTED:Ectropion or entropion.

image Ability to open wide and close completely

Examine with eyes lightly closed, closed tightly, open wide.

EXPECTED:Superior eyelid covering a portion of iris when open.
UNEXPECTED: Fasciculations when lightly closed. Ptosis. Lagophthalmos.
imageEyelid margin UNEXPECTED:Flakiness, redness, or swelling. Hordeola.
imageEyelashes EXPECTED:Present on both lids. Turned outward.
Palpate eyelids
Palpate eye
  EXPECTED:Can be gently pushed into orbit without discomfort.
  UNEXPECTED:Firm and resists palpation.
Pull down lower lids and inspect conjunctivae and sclerae

image Color

Inspect upper tarsal conjunctivae only if presence of foreign body is suspected.

EXPECTED:Conjunctivae clear and inapparent. Sclerae white and visible above irides only when eyelids are wide open.
UNEXPECTED:Conjunctivae with erythema. Sclerae yellow or green. Sclerae with dark, rust-colored pigment anterior to insertion of medial rectus muscle.
imageCondition UNEXPECTED:Exudate. Pterygium. Corneal arcus senilis or opacities.
Inspect lacrimal gland region

image Lacrimal gland puncta

Palpate lower orbital rim near inner canthus. If temporal aspect of upper lid feels full, evert lid and inspect gland.

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Mar 25, 2017 | Posted by in PHYSIOLOGY | Comments Off on Eyes

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