Clinical Eye Examination

Question 1

List the equipment you require for an eye examination

Answer 1

Room capable of being darkened

Pen torch

Condensing lens

Direct ophthalmoscope

Equipment to measure intraocular pressure
	-Schiotz
	-Tonopen
	-Tonvet

Question 2

List the disposable equipment you need during an eye examination

Answer 2

Schirmer Tear Test

Fluorescein

Anaesthetic (e.g. Proxymetacaine)

Tropicamide (dilates pupil)

Question 3

What is the order that an eye exam should be carried out in?

Answer 3

Hands-off examination
Hands-on examination
Schirmer Tear Test
Ocular reflexes
Examination of external structures
Examination of internal structures
Ophthalmoscopy
Fluorescein Staining

Question 4

During the hands-off examination, what should you check?

Answer 4

Assess behaviour

Assess eyes

Eyelid conformation

Size of palpebral fissure

Position of third eyelid

Question 5

During the hands-on examination, what should you check?

Answer 5

Repulsion

Eyelids

Third eyelid

Question 6

What are the principles of the Schirmer Tear Test?

Answer 6

○ To measure tear production
○ Perform early in examination – before applying any drops
○ Normal reading in dogs 15-25mm/min
○ 10-15mm/min suspect KCS (dry eye)
○ <10mm/min confirm KCS in presence of appropriate clinical signs

Question 7

Name the ocular reflexes and describe how you perform each one

Answer 7

Ocular Reflexes
○ Palpebral reflex
Touch medial canthus
Touch lateral canthus

	Checking sensation to eyelid (trigeminal n)
	Checking blink response (facial n)
	
	
○ Menace response
	Cover contralateral eye and flick fingers at the other eye
	
	Try not to create air currents
	
	
○ Dazzle reflex
	Stimulus: very bright focal light shone into one eye
	
	Normal response: both eyes blink and possible head 
            withdrawal
	
	
○ Pupillary light reflexes
	Stimulus: light shone in one eye
	
	Normal response: pupil constricts
		
		Pupil on same side as light constricts (DIRECT PLR)
		
		Contralateral pupil constricts (INDIRECT or CONSENSUAL 
                     PLR)
	
	
○ Vestibulo-ocular reflex

Question 8

Label the external structure you would want to examine

Answer 8

Palpebral fissure

Medial canthus

Lateral canthus

Hairs: eyelid hair, cilia, vibrissae

Third eyelid

Limbus, conjunctiva and sclera

Cornea – should be clear with sharp corneal/purkinje reflex

Question 9

What should you check for when examining the internal structures of the anterior eye?

Answer 9

Anterior Chamber
Should be clear
Iris
Brightly coloured
Pupil
Clear optical axis

    Symmetrical pupils

Question 10

Name the three way ophthalmoscopy can be performed

Answer 10

Close direct
Direct Ophthalmoscope

Distant direct
Direct Ophthalmoscope

Indirect
Pen torch

Condensing lens

Question 11

Describe how fluorescein staining works

Answer 11

Orange dye that turns green in alkaline tears

Adheres to and stains hydrophilic tissues such as exposed corneal stroma

Extremely useful for diagnosis of corneal ulcers

Jones test for nasolacrimal patency

Easily seen by owners to help understanding

Question 12

What is tonometry?

Answer 12

Measurement of intraocular pressure.

Can indicate whether uveitis or glaucoma is present

Question 13

What are the normal IOP values?

Answer 13

Normal IOP Values

10-25 mmHg in the dog and cat
17-28 mmHg in the horse
15-20 mmHg in the rabbit

Difference of >10mmHg between eyes is abnormal

Question 14

What are the three methods of tonometry?

Answer 14

Indentation tonometry (SCHIOTZ TONOMETER)

Rebound tonometry (TONOVET®)

Applanation tonometry (TONOPEN®)