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How to do Eye examination?

An eye examination is a battery of tests performed by an ophthalmologist or optometrist assessing vision and ability to focus on and discern objects, as well as other tests and examinations pertaining to the eyes. All people should have periodic and thorough eye examinations as part of routine care by the primary care physician, especially since many eye diseases are silent or asymptomatic.

Eye examinations may detect potentially treatable blinding eye diseases, ocular manifestations of systemic disease, or signs of tumours or other anomalies of the brain.

Entrance tests:

  • External examination
  • Visual acuity
  • Amplitude of accommodation
  • Color vision
  • Cover test
  • Stereopsis
  • Near point of convergence
  • Extraocular motilities
  • Pupils
  • Visual field screening
  • Interpupillary distance

Refraction:

  • Lensometry
  • Keratometry
  • Retinoscopy
  • Refraction
  • Monocular
  • Binocular balance
  • Cycloplegic refraction

Functional tests:

  • Accommodative system
  • Negative relative accommodation
  • Positive relative accommodation
  • Vergence system

Health assessment:

  • Slit lamp biomicroscopy
  • Direct ophthalmoscopy
  • Binocular indirect ophthalmoscopy
  • Tonometry
  • Amsler grid
  • Visual field assessment
  • Gonioscopy

Advanced techniques:

  • Corneal topography
  • Corneal pachymetry
  • Scheimpflug ocular imaging
  • Retinal tomography
  • Ocular computed tomography
  • Scanning laser polarimetry

What does an Eye examination contain?

Ideally, the eye examination consists of an external examination, followed by specific tests for visual acuity, pupil function, extraocular muscle motility, visual fields, intraocular pressure and ophthalmoscopy through a dilated pupil.

A minimal eye examination consists of tests for visual acuity, pupil function, and extraocular muscle motility, as well as direct ophthalmoscopy through an undilated pupil.

Basic examination:

External examination of eyes consists of inspection of the eyelids, surrounding tissues and palpebral fissure. Palpation of the orbital rim may also be desirable, depending on the presenting signs and symptoms. The conjunctiva and sclera can be inspected by having the individual look up, and shining a light while retracting the upper or lower eyelid. The cornea and iris may be similarly inspected.

Visual acuity:

Visual acuity is the eye’s ability to detect fine details and is the quantitative measure of the eye’s ability to see an in-focus image at a certain distance. The standard definition of normal visual acuity (20/20 or 6/6 vision) is the ability to resolve a spatial pattern separated by a visual angle of one minute of arc. The terms 20/20 and 6/6 are derived from standardized sized objects that can be seen by a “person of normal vision” at the specified distance. For example, if one can see at a distance of 20 ft an object that normally can be seen at 20 ft, then one has 20/20 vision. If one can see at 20 ft what a normal person can see at 40 ft, then one has 20/40 vision. Put another way, suppose you have trouble seeing objects at a distance and you can only see out to 20 ft what a person with normal vision can see out to 200 feet, then you have 20/200 vision. The 6/6 terminology is more commonly used in Europe, and represents distances in meters.

An examination of pupilary function includes inspecting the pupils for equal size (1 mm or less of difference may be normal), regular shape, reactivity to light, and direct and consensual accommodation. These steps can be easily remembered with the mnemonic PERRLA (D+C): Pupils Equal and Regular; Reactive to Light and Accommodation (Direct and Consensual).

A swinging-flashlight test may also be desirable if neurologic damage is suspected. The swinging-flashlight test is the most useful clinical test available to a general physician for the assessment of optic nerve anomalies. This test detects the afferent pupil defect, also referred to as the Marcus Gunn pupil. In a normal reaction to the swinging-flashlight test, both pupils constrict when one is exposed to light. As the light is being moved from one eye to another, both eyes begin to dilate, but constrict again when light has reached the other eye.