ANATOMY OF THE EYE

Anamnesis
1. Chief complaint:
- acute persistent visual loss
- chronic progressive visual loss
- flashes, photopsia
- red eye
- proptosis
- tearing, etc
2. History taking
3. Family history
4. Systemic diseases
 Visual loss
• Abnormalities in media of refraction
🡪 cornea, anterior chamber, lens,
vitreous body

• Abnormalities in neural tissue

🡪 retina, optic nerve
 Ophthalmology examination

COMPONENTS:
• Visual acuity
• Confrontation visual fields
• External examination
• Pupillary examination
• Motility and alignment examination
• Ophthalmoscopic examination
 Ophthalmology examination
Visual acuity

• Determine the smallest object

clearly seen in a certain distance
• Distinguishing 2 separate points
• Visual angle of 5 minutes to see
a letter, but to analyze the form
completely, require resolution of
1 minute arc
 Visual acuity testing
Snellen Chart
• Snellen’s notation:

testing distance
____________________

distance of the line of

smallest letters readable

• Notation
- Fraction of 6/50 - 6/6 (6/5)
- Decimal
 PINHOLE TEST
• If visual acuity is not
normal
• Determine if it is:
- optical (refractive error
or media opacity)
- neural (retinal or optic
nerve lesion)
Pinhole: eye shield with a small hole allowing
• Improved: optical light rays to reach retina without interference
of optical problems
• Not improved: - neural
- poor compliance
 Low vision

• Counting fingers (1/60 - 5/60)

• Hand movement (1/300): vertical and
horizontal
• Light perception (1/~)
• No light perception
 Refraction
Refraction Near vision/reading

Picture chart
CONFRONTATION TEST

Distance of 1 m
Examiner considered normal
 External examination
1. Anterior segment:
– Eyebrows, eyelids, tarsal conjunctiva, bulbar
conjunctiva, cornea, anterior chamber, iris,
pupil, and lens
(at least, use a penlight; if available: loupe)

2. Posterior segment:
– Vitreous, retina, optic disc
Ciliary injection

Conjunctival injection

Red eyes Scleral injection

ANTERIOR CHAMBER

HYPOPIO
N
FLUORESCEIN TEST
CORNEAL SENSITIVITY TEST
 IRIS

• Crypti

• Color

• Synechia

• Iridodialisis
 LENS

• Katarak
• Shadow test
Immatur Mature
e

CATARACT

Morgagnian Hypermature
Senile cataract
 Pupillary examination

• Pupil size (in dim and light)

• Swinging light test (if dilated: Marcus Gunn
pupil or relative afferent pupillary defect)
🡪 optic neuritis, retinal detachment,
vein/artery occlusion
• Anisocoria
Motility and Alignment
Examination

Extraocular
muscles
Ocular alignment
ESOTROPIA

EXOTROPIA

HYPERTROPI
A
HYPOTROPI
A
Corneal light reflection test

Normal (ortho)

15 * ET (esotropia)

30* ET

≥45 *ET
OCULAR MOVEMENTS

• Cardinal Gaze
Fields
• Convergence
• Diplopia
• Nystagmus
CARDINAL GAZE FIELD
OPHTHALMOSCOPY
FUNDUS EXAMINATION
• Reflex

• Optic disc

• Arteries & Veins

• Macula

• Retina
Syatematic fundus examination
Optic disc

• Normal

• Large cupping

• Glaucomatuos
cupping
 Other examinations
• PERIMETRY/CAMPIMETRY

• TONOMETRY

• EXOPHTHALMOMETRY

• ANEL TEST

• SCHIRMER TEST

• COLOR VISION
GOLDMANN CAMPIMETRY
Digital Palpation

2
hands

1 hand
SCHIOTZ TONOMETER

Callibration
VARIOUS TONOMETERS
ANEL TEST
HERTEL EXOPHTHALMOLMETER
SCHIRMER TEST
Color vision tests:
ISHIHARA PLATES
THANK YOU