A comprehensive eye examination involves evaluating visual function, ocular structures, and neurological components. It is performed systematically using subjective and objective assessments to diagnose refractive errors, infections, inflammatory conditions, systemic diseases, and neurological disorders.
This guide provides a detailed step-by-step clinical approach to ophthalmic examination, correlating it with both Ayurvedic (Drik Pariksha) and Modern Methods.
I. Comprehensive Clinical Eye Examination – Stepwise Approach
1. Patient History (Ophthalmic History Taking)
- Chief Complaint: Blurred vision, pain, redness, photophobia, floaters, etc.
- Onset & Duration: Sudden (Emergency) vs. Gradual (Chronic)
- Associated Symptoms: Headache, systemic illness (diabetes, hypertension)
- Past Ocular History: Surgeries, trauma, medications (steroids, anti-glaucoma drugs)
- Family History: Glaucoma, Retinitis Pigmentosa, Macular Degeneration
II. Visual Function Tests
1. Visual Acuity Testing
Used to assess sharpness and clarity of vision.
| Method | Purpose | Procedure | Findings |
|---|---|---|---|
| Snellen Chart | Distance Vision | Read letters from 20 feet | 6/6 (Normal), 6/12 (Mild defect), 6/60 (Severe defect) |
| Jaeger Chart | Near Vision | Read printed text from 14 inches | Presbyopia, Hyperopia |
| Pinhole Test | Refractive Error | Patient looks through pinhole aperture | Vision improves = Refractive error, No improvement = Pathology |
| Color Vision (Ishihara Test) | Detects color blindness | Patient reads colored number plates | Defective in Red-Green blindness |
| Contrast Sensitivity Test | Identifies early cataracts & retinal disorders | Grayscale contrast chart | Abnormal in Cataract, Optic Neuritis |
2. Visual Field Testing (Perimetry)
Used for Glaucoma, Optic Neuropathy, Stroke.
- Confrontation Test: Quick bedside method
- Automated Perimetry (Humphrey Test): Maps visual field defects
III. External Eye Examination
- Eyebrows, Eyelids, Lashes: Ptosis, Blepharitis, Chalazion
- Conjunctiva & Sclera: Redness, pallor, subconjunctival hemorrhage
- Cornea: Cloudiness (Keratitis, Edema)
- Pupil (Pupillary Reflex Test):
- Direct & Consensual Light Reflex: CN II & III
- Swinging Flashlight Test: Detects RAPD (Optic nerve damage)
IV. Slit Lamp Biomicroscopy
A high-magnification examination of anterior segment structures.
| Structure | Findings | Possible Condition |
|---|---|---|
| Cornea | Opacity, Infiltrate | Corneal Ulcer, Keratitis |
| Anterior Chamber | Hypopyon, Hyphema | Endophthalmitis, Trauma |
| Iris & Pupil | Irregular shape, Synechiae | Iritis, Uveitis |
| Lens | Opacities | Cataract |
| Vitreous | Floaters, Hemorrhage | Diabetic Retinopathy |
V. Intraocular Pressure (IOP) Measurement – Tonometry
Essential for glaucoma diagnosis.
| Method | Technique | Normal Range | Clinical Application |
|---|---|---|---|
| Goldmann Applanation Tonometry (GAT) | Uses fluorescein dye & blue light | 10-21 mmHg | Gold Standard |
| Non-contact (Air Puff) Tonometry | Uses air puff to flatten cornea | 10-21 mmHg | Screening Test |
| Rebound Tonometry | Uses handheld probe | 10-21 mmHg | Portable, No anesthesia |
- Increased IOP (> 21 mmHg): Glaucoma
- Decreased IOP (< 10 mmHg): Ocular Hypotony, Uveitis
VI. Fundoscopy (Ophthalmoscopy) – Retina & Optic Nerve Evaluation
Fundoscopic examination helps detect retinal, vascular, and optic nerve diseases.
| Finding | Condition |
|---|---|
| Papilledema | Increased ICP (Brain Tumor, Hydrocephalus) |
| Optic Atrophy | Glaucoma, MS, Optic Neuritis |
| Diabetic Retinopathy | Microaneurysms, Hemorrhages, Cotton Wool Spots |
| Hypertensive Retinopathy | AV Nicking, Cotton Wool Spots |
| Macular Degeneration | Drusen Deposits |
- Direct Ophthalmoscopy: Close examination of retina
- Indirect Ophthalmoscopy: Wide-field retina assessment
- Fundus Fluorescein Angiography (FFA): Retinal vessel analysis
VII. Advanced Imaging Techniques
Used for in-depth analysis of eye diseases.
| Test | Purpose | Conditions Diagnosed |
|---|---|---|
| Optical Coherence Tomography (OCT) | Cross-sectional retinal imaging | Glaucoma, Macular Edema |
| B-Scan Ultrasonography | Detects intraocular pathology | Retinal Detachment, Tumors |
| Fluorescein Angiography (FA) | Retinal vessel perfusion | Diabetic Retinopathy, AMD |
| Electroretinography (ERG) | Retinal function test | Retinitis Pigmentosa |
VIII. Systemic Conditions Diagnosed Through Eye Examination
Many systemic diseases present with ocular manifestations.
| Systemic Disease | Ocular Signs | Test Used |
|---|---|---|
| Diabetes Mellitus | Diabetic Retinopathy | Fundoscopy, OCT |
| Hypertension | Hypertensive Retinopathy | Fundoscopy |
| Hyperthyroidism (Graves’) | Proptosis, Lid Lag | Exophthalmometry |
| Multiple Sclerosis (MS) | Optic Neuritis | OCT, VEP |
| Autoimmune (Lupus, RA) | Uveitis, Scleritis | Slit Lamp, OCT |
IX. Flowchart for Systematic Eye Examination
plaintextCopyEdit Patient presents with eye symptoms
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┌────────────────────────────────────┐
| Step 1: History Taking |
└────────────────────────────────────┘
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┌────────────────────────────────────┐
| Step 2: Visual Acuity Test |
└────────────────────────────────────┘
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┌───────────────────────────────┬───────────────────────────────┐
| External Eye Exam | Pupil & Reflex Test |
└───────────────────────────────┴───────────────────────────────┘
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┌───────────────────────────────┬───────────────────────────────┐
| Slit Lamp Biomicroscopy | Tonometry (IOP) Test |
└───────────────────────────────┴───────────────────────────────┘
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┌───────────────────────────────┬───────────────────────────────┐
| Fundoscopy (Retinal Exam) | Advanced Imaging (OCT, FA) |
└───────────────────────────────┴───────────────────────────────┘
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Final Diagnosis & Treatment Plan