BASIC OF OPHTHALMOLOGY EXAMINATIONS

Ophthalmology examinations
1. General eye examinations :
Anamnesis Physical of eye exam Visual function evaluation

2. Specific eye examinations

ANAMNESIS
Purpose : to pursue the eye diseases history two methods: :
Autoanamnesis (directly to the patients Cooperative) Alloanamnesis (Family of the patients non cooperative)

The collected informations : : 1. General : Identites (name, age, gender, address, job, and so on) 2. Specifics : a. Chief of complain : blurred of vision, dyplopia, pain,irritatif, red eye, trauma b. Other of clinical signs link to the main complain : onset, progressitivity, duration, reversibility, lacrimation, disturbance of eye motility, histrory of trauma, glasses, systemic diseases (DM, HT), and so on

Physical of eye exam

1. Inspection anterior segment of eye ball 2. Oblique illumination anterior segment of eye ball 3. Palpation finger tension pain pressure (uveitis) Tumor mass adenopathy (Preaurikuler gland) 4. Visus 5. Refraction 6. Intra ocular pressure 7. Visual field 8. Ophthalmoscopy

1. Inspection
No equipment Examiner directly observe the eye (good illumination room) The evaluated structures :
Eyelid : supercilia, cilia, skin, fissura, plica, canthus, conjunctiva (eyelid eversion) comparing the right and left eyes Anterior segment of the eye : 1.Conjunctiva: injeksio, redness,chemosis,bleeding, laseration, foreign bodies.

Sclera : color, thickness, or trauma Cornea : diameter, curvature, intact (trauma). Anterior chamber : contents, deep or shallow. Iris : color, vasculature, crypte Pupil : Form, position, color, margin, number Lens : transparancy, position (trauma) Eye movements

2. Oblique Illumination
Equipments : pen light Technique ? : What are the visible structures : more detail than inspection ?

Oblique illuminations
The evaluated structures : 1. Eye lid : (= inspection) 2. Anterior segment : clearer the inspection
a. Cornea : cikatriks nebula, small foreign body, blood stain b. Iris : kripte, sinekia c. Anterior chamber : contents (hyphema, hypopion) d. Pupil : direct/ indirect pupil reflex, regularitasity pupil margin e. Lens : iris shadow & pseudo iris shadow

Light reflex in the pupil

Myosis

Mydriasis

Anatomy

Physiology

Pen light evaluate : : Hirschberg test (strabismus) Light perception test (visus = 1/) Light projection test (retinal function)

3. Palpation
No equpments, only the finger 1. Tumor mass 2. Palpable of pre auriculer gland 3. Pain pressure (iridocyclitis/uveitis) 4. Finger tension (high of IOP)

Tumor mass : consistency, pain pressure, pulsation +.

Palpable of pre auriculer gland

- Cancer spreading - Viral infection of the eye

Palpation for IOP : Technique ? CSL . Spesial sense system !

 Results : 5 category :

Tn .. Normal IOP Tn 1 Low of IOP Tn 2 . ..Very low of IOP Tn + 1. High of IOP Tn + 2. Very high of IOP

4. Intra ocular pressure evaluations

Direct & Indirect methods
Direct : Introducing canula to anterior chamber and link to manmeter.
For animal study and experiment

Inderect : 2 methodes : 1. finger tension 2. Tonometer : contact and non contact.

Tonometri
Tonometer Schiotz Tehnique : CSL of Special Sense system !

Hasil Pemeriksaan

Ditulis dalam bentuk 2 angka Angka pecahan (tanpa satuan) : sebagai pembilang adalah skala dan beban sebagai penyebut. Angka desimal : dapat diperoleh pada tabel yang ada pada tonometer dengan cara menarik garis hayal horisontal.

5. Visual field (VF) testing

Purpose : to determine the peripheral visual field
Normal VF : Nasal/Medial field Temporal field Superior field Inferior field

= 60 0 = 90 0 = 70 0 = 50 0

VF defects contribute to :
a. Diseases dignosis b. Locations of lesions in retina, visual cortex area in the brain

Examination tests : 1. Confrontaion test (CSL special sense) 2. Amsler grid 3. Perimetri (Goldman VF testing 4. Tangent Screen (campimeter)

7. Visual evaluations
Visual Acuity: the ability of the eye to percept the detail and clear objects. Classification : based on reading distance : 1. Distance visual test : reading distance > 20 feet (5 meter) 2. Intermediate visual test 3. Near visual test : reading distance (1/3 meter)

Distance visual testing Sinonim : Central visual testing Equipments: 1. Reading chart a. Snellen chart (alphabet or numbering) b. E chart (E) c. Allen chart (easy picture) 2. Reading distance 5 or 6 meter 3.Optimal room illumination
Technique ? CSL

Reading-object shifting :

1. Counting Finger (CF) ; reading value : 60 2. Hand movement/hand motion (HM) ; .reading value 300 3. Light perception (LP) ; ..reading value (unlimited value)
4. No light perception : visus = 0

Visual testing results : - 5/40, 1/60, 1/300 and so on - 1,0 ; 0,5 ; 0,1
Ex: VOD : 1/60 = Visual acuity of the right eye is the ability of patient to only see object at 1 meter while the normal individual can see in 60 meter.

8. Refraction test
To indentify the refraction errors : Myopia, Hyperopia, astigmatism Eq. : Snellen Chart & Trial Lenses Therapy : glasses, contact lens, LASIK

9. Posterior segment examinationa ???

Eq.: = Funduscopy/ ophthalmoscopy

RETINA

Ophthalmology scopes :
1. 2. 3. 4. 5. 6. 7. 8. 9. REFRACTION LENS AND CATARACT VITREO-RETINA EXTERNAL EYE DISEASES (EED) TUMOR OF THE EYE TRAUMA DAN RECONSTRUCTION PEDIATRIC AND STRABISMUS NEUROOPHTHALMOLOGY SOCIAL OPHTHALMOLOGI

EYE DISEASES SYMPTOMS

1. 2. 3. 4. 5. RED EYES BLINDNESS Abnormal Structures and positions TRAUMA Systemic and eye syndrome

RED EYE
RED EYE WITH IMPAIR/DECREASE OF VISUAL ACUITY Ex. : Uveitis, Keratitis, acute glaucoma, trauma
RED EYE WITH NORMAL VISUAL ACUITY Ex. : conjunctivitis, Episcleritis, Pterygium

BLINDNESS
SUDDEN BLINDNESS (SUDDEN VISUAL
LOSS)
Ex. : Retinal detachment, neuritis, vitreous bleeding CHRONIC VISUAL LOSS Ex. : cataract, non acute glaucoma, retinitis pigmentosa refraction errors (=myopia, hyperopia, astigmatism)

Abnormal Structures and positions

Eyelid : ptosis, ectropion, intropion dll. Eye ball : strabismus Structure : microphtalmia, keratoconus, bulls eye. Proptosis: extra and intraokuler mass

TRAUMA
PERFORANS TRAUMA NON- PERFORANS TRAUMA (BLUNT TRAUMA) CHEMICAL TRAUMA (ACID OR ALKALI FOREIGN BODIES OF THE EYE BALL

SYSTEMIC/SYNDROMIC EYE DISEASES

SYSTEMIC : Diabeic retinopathy Graves ophthalmopathy Hipertensive retinopathy SYNDROME : Marfan syndrome Weil -Maschesani syndrome Terson syndrome Stickler syndrome