case study

A. Visual acuity (Snellen chart, E chart, animal and object test, Rosenbaum near-vision chart)

B. Visual fields (confrontation test)

II. Inspection and palpation of the eyes

A. Eyebrows for size, hair texture, and extension to temporal canthus

B. Orbital area (edema, redundant tissues, or lesions)

C. Eyelids (ability to open and close, eyelash position, ptosis, fasciculation, tremors, flakiness, redness, swelling); palpate for nodules

D. Conjunctivae and sclerae: color and condition (discharge, pterygium, lacrimal gland punctum, foreign bodies)

E. External eyes: corneal clarity, sensitivity, arcus; color of irides; pupillary size and shape, response to light and accommodation, nystagmus

F. Lacrimal gland condition

G. Extraocular muscles (corneal light reflex, cover–uncover test, six cardinal fields of gaze)

III. Ophthalmoscopic inspection (hold the ophthalmoscope in the hand that corresponds to the examining eye)

A. Lens clarity

B. Red reflex

C. Retinal color, lesions

D. Blood vessel characteristics

E. Disc characteristics

F. Macula characteristics (ask the patient to look directly at the light)

G. Depth of anterior chamber