Eyes

Question 1

Describe the step-by-step approach to assessing the anterior segment of the eyes.

Answer 1

Ask the patient to look straight ahead and inspect both of the eyes assessing the following:
* Peri-orbital regions
* Eyelids
* Eyes (including pupils)

Note any abnormalities such as:
* Swelling
* Redness
* Discharge
* Prominence of the eyes
* Abnormal eyelid position
* Abnormal pupillary shape, size and/or asymmetry

Pupillary assessment: Inspect the patient’s pupils for abnormalities.
* Pupil size
* Pupil symmetry
* Pupil shape
* Pupil colour

Assessment using white light
* Set up your Ophthalmoscope (geeky medics)
* Stand to the side of the patient and place your hand on the patient’s forehead to prevent an accidental collision.
* Carefully approach the right eye with your right eye, until the front of the eye comes into focus. On the ophthalmoscope, this will vary depending on the power of the lens selected. If using the Arclight, the front of the eye will be in focus at 6 cms.
* Ask the patient to look outwards and then inwards. Note the various structures whilst looking for any abnormalities.
* Ask the patient to look upwards whilst you gently hold their lower eyelid to assess the lower areas of the eye ball and lids.
* Then ask the patient to look downwards whilst you gently hold their upper eyelid to assess the upper areas.
* Assess the depth of the anterior chamber (the space between the cornea and the iris):
* Shine a light from the temporal side of the eye to assess the depth

Equipment:
* Ophthalmoscope (traditional device or Arclight)
* Fluorescein eye drops
* Cotton bud (for everting the eyelid and manipulating the conjunctiva)
* Local anaesthetic drops if available

Question 2

Describe the step-by-step approach to eyes examination.

Answer 2

• Inspection of the front of the eye + Fundoscopy
• Visual acuity
• Visual fields

Full eye examination should be verbalised:
* Front of the eye - Torch/slit lamp
* Back of the eye - fundoscopy
* Visual acuity (how far you can see)
* Visual fields ( how wide you can see)
* Pressure of the eyes - TonoPen.

Assume that you have to perform on both eyes unless examiner tells you otherwise.