Guide to the Eye Examination

It is estimated that 2% of patients attending their GP have some forms of eye complaints.
History and appropriate eye examination can usually unravel the underlying problems and
help in deciding the need or urgency of ophthalmic referrals.

History is an important part of the examination. Patients with sudden onset visual loss or
painful red eye usually require ophthalmic opinions. Previous similar episodes should be
noted as conditions such as herpes simplex keratitis and iritis can recur. History of
industrial injury should be recorded as it may have medicolegal implication.

Instruments for eye examination in the general practice should include:
  • Snellen chart
  • Magnifier preferably X8
  • Torch with a blue filter
  • Fluorescence drop or fluorescence impregnated paper
  • Topical anaesthesia
  • Topical short acting mydriatic preferably tropicamide

All patients with eye complaints should have distant visual acuity recorded using a Snellen
chart. Glasses should be used if worn. In patients with severe blepharospasm from pain,
topical anaesthesia should be instilled and the visual acuity rechecked.
The examination techniques should be tailored according to the patients complaints.

In patient with red eye:

1. Eyelids and the anterior segment examined with the magnifier in patients with red eyes

2. Check the integrity of the corneal epithelium by instilling fluorescein. Any corneal
    defect will show up green when examined with a blue light.

3. Eversion of the upper lid should be performed in patient with corneal staining suggestive
    of abrasion as there may be subtarsal foreign body. This is performed by instructing the
    patient to look down and evert the lid against a cotton bud.

In patients with blurred vision:

1. Visual field examination by confrontation to check that the patient can see each quadrant.

2. Pupillary reaction to light. Test that the pupils react to light directly and consensually, then
    perform the swinging light test. The swinging test is performed by shining light into one eye
    and then the other. In normal reaction the pupil should constrict each time the light is shone.
    If the pupil dilates, a relative afferent pupillary defect is present and this is indicative of a
    significant retinal problem or optic nerve dysfunction.

3. Dilate the pupil with tropicamide and examine the fundus starting with the optic disc, the
    blood vessels, the macula and the periphery.
    Click here for "How to use direct ophthalmoscope"

Other presenting problems and their examination are detailed in the appropriate sections.

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