Ocular Examination

Question 1

External Examination

Adnexa

Answer 1

• Gross examination with naked eye.
• Use slit lamp or magnifying loupe if abnormalities detected.

Question 2

External Ocular Surface Examination

Answer 2

Examination includes:
Conjunctiva and sclera.
Preferably using slit lamp.
Pen torch and magnifying loupe can be alternatives.
Direct ophthalmoscope at highest + lens for magnification.

Question 3

Cornea Examination

Answer 3

Best done using slit lamp.
Examine corneal structures:
Endothelium, limbal structure, anterior angle.

Question 4

Anterior Chamber

Answer 4

Fluid-filled space.
Should be optically clear.

Question 5

Iris Examination

Answer 5

Evaluate color and pigmentation.

Question 6

Crystalline Lens

Answer 6

Best examined under slit lamp.
Look for clarity and layered structure.

Question 7

Vitreous Humor

Answer 7

Optically clear jelly-like substance.
Anterior vitreous examined with slit lamp.
Posterior vitreous examined with direct ophthalmoscopy or slit lamp with auxiliary lens.

Question 8

Important Note

Answer 8

Avoid examining macular area first in undilated patients.
Causes pupillary light reaction and meiosis.
Wait for pupil to dilate again to view peripheral structures.

Question 9

Optic Nerve Head

Answer 9

Key feature of fundus examination.
Exit point for ganglion cell fibers carrying visual signals.
Used as an anchor during examination.

Question 10

Optic Disc

Answer 10

Oval-shaped structure with the optic cup in the center. Key features include cup-to-disc ratio, neuroretinal rim, and disc edge.

Question 11

Cup-to-Disc Ratio

Answer 11

This is the ratio of size of the dimension of the optic cup to the optic disc. It is often difficult to detect the transmission from the optic cup to the neuroretinal rim, colour transmission is not always reliable, so we should look at other examples like the bending of the blood vessels when exiting the optic cup

Question 12

Vessel Crossing

Answer 12

The retinal vessels have a tendency to cross each other as they spread across the retina. The variation in the anatomical pattern of these crossing are often important diagnostic signs of systemic disease although, they can also happened with arteriosclerosis with normal aging

Question 13

Venous nipping

Answer 13

This occurs when an artery crossing over a vein and as a complication of arteriosclerosis or systemic hypertension the artery compresses the vein making it narrowed

Question 14

Salus sign

Answer 14

This is when during the AV crossing the effect of the artery is deviate the vein to cross almost in a right angle triangle to the arterial vessel

Question 15

Blood vessel tortuosity

Answer 15

Blood vessel tortuosity is important to evaluate with abnormal tortuosity and it can be indicative of systemic hypertension

Question 16

Colour of blood vessels

Answer 16

The appearance of variation of colour across the lumen should always be notes. This is also known as copper or silver wiring

Question 17

Calibre variations

Answer 17

The variations in the calibre of blood vessels should always be noted, sometimes knows as venous bleeding and focal arteriole narrowing

Question 18

Retina and periphery

Answer 18

It is also important to note down the characteristics of peripheral retina. The presence, degree and distribution of the retina should also be noted as it determines the overall appearance of the fundus

Question 19

Macula and fovea

Answer 19

Macula should be examined last to avoid pupil miosis in undialeted patients. The macula is an avascular structure with the fovea representing the centre point. The fovea is the part of the retina that gives us maximum visual acuity so any abnormalities should be detected

Question 20

Disc Edge

Answer 20

The edge of the disc where it joins the retina represents a key attachment points of the retina with the underlying structure. The other key point of attachment of the retina is with the orra serrata around the equator, which can only be adequately seen with mydriasis and indirect ophthalmoscopy. The edge of the disc is sometimes well defined, particularly if there is a pigment ring around the edge however, if there is no pigment and the patient has a pale retina the disc edge can be poorly defined

Question 21

Blood vessels

Answer 21

The retinal blood supply is important to examine because of its importance to supply blood to the inner layer of the retina and also for signs of any systemic disease which can be observed if there is changes to the retinal blood vessels. Diabetic retinopathy is one of the earliest signs of diabetes which can be noticed in patient and can be seen very easily by the presence of small dots, blot haemorrhages and hard exudates on the fundus. Generally the arterial vessels appear brighter and narrower whilst the veins appear darker red and thicker

Question 22

A/V ratio

Answer 22

The A/V ratio expresses the diameter of the corresponding retinal arteries and veins as a ratio. When comparing the blood vessels should be same in terms of how many branches are coming out of the main vessel when exiting the optic disc. Generally a healthy eye has an A/V ratio of 2/3.