Opthalmic Exam

Question 1

What are the 4 main steps in an opthalmic exam?

Answer 1

1. Observation, 2. Schirmer Tear Test, 3. Examination with Light, 4. Further Diagnostic Tests

Question 2

What are you looking for when observing in an opthalmic exam?

Answer 2

Facial symmetry, occular symmetry. Important not to touch the eyes.

Question 3

When should you do a Schirmer tear test-1 during an opthalmic exam?

Answer 3

Before use of light and before manipulation of the eye.

Question 4

What is a normal and abnormal reading in a Schirmer tear test?

Answer 4

Normal: >15mm/min
Abnormal: <10mm/min
Grey area inbetween, put into context

Question 5

Why is it important to put Schirmer tear test results into context? What must you remember to do? In which disease will you see a difference between the eyes?

Answer 5

Increase in tears with pain, so may have less than normal but is painful. Always measure both eyes and compare. KCS (Dry Eye) is asymmetrical and progressive.

Question 6

What are the three important techniques used in examination with light?

Answer 6

1. Transillumination/slit exam, 2. Direct Opthalmoscopy, 3. Indirect Opthalmoscopy

Question 7

What is transillumination/a slit exam used to examine in the eye?

Answer 7

Examine the anterior structures of the eye, both the non-transilluminable (eyelid, conjunctiva, third eyelid) and the transilluminable (cornea, iris, anterior lens). Also good for looking at the Dazzle reflex and PLR. Important to examine surface contour.

Question 8

What anterior structure in the eye is the slit exam good at examining? What types of things might you find here?

Answer 8

The anterior chamber of the eye. May find hyphema, hypopion, tyndall effect, keratic precipitates (make sure you know what these mean!!)

Question 9

What is the difference between direct and indirect opthalmoscopy?

Answer 9

Direct opthalmoscopy you look directly through the opthalmoscope. Indirect opthalmoscopy looks indirectly at an image of the fundus using an opthalmoscope (not directly) and a 30D lens.

Question 10

What are the two types of direct opthalmoscopy? How do they differ? Which should you start with?

Answer 10

Distant direct opthalmoscopy (DDO) - aim to retroilluminate the eye and get the tapetal reflex. From a distance.
Closed direct opthalmoscopy (CDO) - upclose illuminate both eyes.

Question 11

What type of opthalomoscopy (indirect, closed direct, or distant direct) are used to differentiate nuclear sclerosis from cataracts? How?

Answer 11

Distant direct opthalmoscopy - by aiming to use the tapetal reflection and retroilluminate the lens.

Question 12

How do you differentiate nuclear sclerosis from cataracts? How?

Answer 12

Distant direct opthalmoscopy by aiming to use the tapetal reflection and retroilluminate the lens.

Question 13

What type of opthalomoscopy (indirect, closed direct, or distant direct) are used to examine the posterior segment?

Answer 13

Indirect opthalmoscopy and closed direct opthalmoscopy.

Question 14

What type of image do you see when using indirect opthalmoscopy? Is there a bigger or smaller field of view?

Answer 14

Inverted, Left to right, virtual image. There is a bigger field of view as it is less magnified.

Question 15

What setting on the lens wheel should be used for direct opthalmoscopy (closed and direct)?

Answer 15

Neutral setting

Question 16

How do nuclear sclerosis and cataracts appear different when using distant direct opthalmoscopy to look at the lens?

Answer 16

Nuclear sclerosis appears transparent, cataracts appear black.

Question 17

What additional techniques can be used in an opthalmic examination?

Answer 17

Fluoroscein staining, Jones test, Tonometry, gonioscopy and imaging.

Question 18

What does fluoroscein staining test? How does it work?

Answer 18

Tests the integrity of the cornea e.g. a corneal ulcer (epithelium is hydrophobic, underlying stroma is hydrophilic). Leave for one minute and flush out of eye. Shine blue light on it to fluoresce.

Question 19

What does the Jones test test? How does it work?

Answer 19

Using fluorescein to test nasolacrimal duct patency. Put in eye, do not flush, wait about 4 mins, and should see some of fluorescein coming out of nose. If no fluorescein, it suggests NLD blockage, and warrants flushing.

Question 20

What does the Tonometry test? What is normal? What does higher or lower than normal suggest?

Answer 20

o Measures intraocular pressure (IOP)
o Normal = 12-22(24)
o Increased suggests Glaucoma, decreased suggests Uveitis.

Question 21

What does Gonioscopy measure?

Answer 21

Measures the iridocorneal angle. Specialist tool.

Question 22

What is the Schrimer tear test-1 used to measure?

Answer 22

Tear production in the eyes.