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Eye Examination (7. Pupil assessment (Direct/Consensual light reflex
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Eye Examination
7. Pupil assessment
Direct/Consensual light reflex
- Ask pt to look into distance
- Shine light into each pupil
Direct Response
- Pupil directly exposed to light constricts
Consensual Response
- Pupil of opposite eye not exposed directly to light also constricts
RAPD test
- Swing light across both eyes
- Normal = both pupils constrict
(constrict-constrict-constrict-constrict ---> no RAPD/PERLA)
- Abnormal = e.g. affected left eye dilates rather than constricts
(constrict-dilate-constrict-dilate ---> LE RAPD)
Observe pupil size, shape & symmetry
6. Assessing strabismus
Corneal light reflex
- Shine light in centre of both eyes
- Observe where light reflex locates in reference to pupil
Cover-Uncover test
- Ask pt to fixate on distant object
- Cover one eye
- Observe movement in uncovered eye
- Normal = no movement in uncovered eye
1. Visual Acuity
- Ask if pt wears gls/cls
- Test one eye at a time
- Pt reads Snellen chart from 6m
- Record smallest line able to read
- If unable to read 6/60:
- Bring chart 1m closer each time (e.g. 2/60)
if not
- Ask to count fingers (CF)
if not
- Ask if can see hand movement (HM)
if not
- Ask if can perceive light (PL/NPL)
2. Inspection
- Peri-orbital area
- Eye lids/lashes/margins- bruising, swelling, crusting
- Cornea
- Sclera
- Iris
- Pupil
- Conjunctiva
3. Visual Field
- Sit opposite pt
- Tell pt to cover one eye
- Cover same side as pt
- Ask pt to tell you when they see your finger from periphery
- Wiggle finger at 2,4,8,10 o'clock
- Repeat with other eye
4. Extra-ocular movement
- Sit opposite patient
- Ask pt to follow your finger whilst keeping head still
- Trace a 'H' in front of pt
- Watch for nystagmus
- Ask for diplopia
- Bring finger directly in towards pts nose
- look for pupil constriction & convergence
5. Near reaction
- Ask pt to fix gaze on distant object
- Swap gaze to closer object
- Observe pupil constriction
8. Fundoscopy
- Ask patient to fixate on distant object
- Rest hand on pt head/shoulder
- Check for bilateral red light reflex
- Begin at arms length away, 15 degrees temporal
- Observe retinal arterioles/venules
- Follow branches until optic disc is seen
- Assess 3C's - colour, cup, contour
- Ask pt to look directly into light to view macula