Ocular examination / anterior segment examination
1. Vision
Visual acuity (cover one eye)
- Snellen’s chart (at 1m)
- If can’t see E on snellen’s
chart use Counting fingers
(1,2,5)
- Hand movement (at 50cm or
less)
- If can’t see hand movement
check PL (perception of
light)
• If abnormal, Tell the
examiner you would like to
do pin hole test to exclude
refractory error
• Comments
- Left eye , 6/60 ,
unaided
2. Inspection
- Face (any syndromic features)
- Size/position of eyeball (normal/abnormal) - proptosis
- Ocular alignment
- Lids (swelling/any abnormality?) – ptosis, ectropion,entropion
- Lacrimal sac region (any swelling?)
- Watery eye / discharge
3. Check the 6 components
Conjunctiva
• White / Injected (generalized/localized)
• Discharge
- Clear watery
- Purulent
Extraocular muscle motility (EOM) Visual field
(patient and examiner need to cover
one eye)
- Head fixed, eyes follow - Ask patient to look at you and
examiner’s finger fixed the head
- Do H shaped (full range) and go - Do the X shaped (4 quadrants)
near to the nose • Comments
- When do downward movement, - No visual field defect for
lift up the lid both eyes in all 4
• Comments quadrants
- No limitation of movements
in all direction
- No pain
- No nystagmus
- No diplopia (double vision)
Bright Light
Cornea Anterior Chamber (AC)
• Clear • Deep / shallow
• Opacity • Quiet / abnormal content
- Central / peripheral - Hypopyon
- Size approximately (total cornea - Hyphema
diameter 12mm)
• Corneal sensation Comment
- Ophthalmic branch of trigeminal • Anterior Chamber is deep and quiet
nerve (CN V) • Anterior chamber is shallow and there is
presence of hypopyon
Comment
• Cornea is clear and I would like to do
corneal sensation test by applying light
touch with cotton wool on cornea
- to check for ophthalmic branch
of trigeminal nerve
• There is cornea opacity centrally with
approximately 5 x 5 mm size, and I would
like to do corneal sensation test by
applying light touch with cotton wool on
cornea
 Dim Light
Pupil Lens Retina
• Round • Clear *Normally in undilated pupil you can’t
• Regular • Opacity appreciate optic disk and macula.
• Symmetrical - Immature/mature cataract
- Don’t say symmetrical when • Red reflex • Optic Disk
patient is given atropine dilator - Present - Colour: pink
(dilated/ constricted) - Reduce (immature cataract) - Contour: regular
• Light reflex - Absent (mature cataract) • Macula
1. Direct • Aphakia/phakia/ pseudophakia - Haemorrhage
▪ Normal: Constricted pupil • Subluxated/dislocated - Exudate
▪ Test for afferent sensory nerve
(Optic nerve) Comment Comment
2. Consensual (look at the opposite • There is lens opacity with reduced red • On fundoscopic examination of retina,
eye) reflex optic disk is pink with regular contour
▪ Normal: Constricted pupil • Say Pseudophakia if you know patient had and there is no macula haemorrhage or
▪ Test for efferent motor nerve lens impant done (IOL) exudate
(Oculomotor nerve)
3. RAPD (swinging light test)
▪ Normal: Constricted pupil
▪ Test for Relative Afferent
Pupillary Defect (RAPD) for optic
nerve

Comment
• BST HTAR: “Pupil is round and reactive to
light”
• Pupil is round and not symmetrical as RE
pupil is more dilated than LE pupil, and
Light reflex is normal