OSCE: Eye Exam

Question 1

What structures do you inspect in an eye exam?

Answer 1

Position and alignment of the eyes 
Eyebrows for hair and scaliness
Conjunctiva
Sclera 
Cornea
Iris
Pupils 

Ask patient to look upward as lower lids are pulled inferior, the look downward as upper lids are pulled superior.

Question 2

With the ophthalmoscope, what structures are identifiable in the posterior chamber?

Answer 2

Optic disc: nasal and inferior

Arterioles: 2 lateral and 2 nasal (brighter and thinner than venules)

Question 3

What is leukocoria?

Answer 3

AKA “white reflex”

• Indicates a serious pathology in the eye, most commonly a congenital cataract
• Can also be an indicator of retinoblastoma, retinal detachment, or other more serious conditions

Question 4

What is retinoblastoma?

Answer 4

Neuroectodermal malignancy arising from embryonic retinal cells
-Rare cause of childhood blindness
-Most common presenting sign is
leukocoria

Question 5

What is nystagmus?

Answer 5

Ocular ataxia or rhythmical oscillation of the eyes

Question 6

How does the caloric reflex test work?

Answer 6

Caloric reflex test or vestibular caloric reflex stimulation is important for CNS function testing

• Eyes are deviated towards the ear being tested with cold water.
• Eyes are deviated away from the ear being tested with warm water

Question 7

What is the “Static Finger Wiggle test”?

Answer 7

1. Ask patient to look directly into your eyes as you stand about an arm’s length away
2. Imagine a bowl between you and hold your fingers at arm’s length and wiggle your fingers as you move them along the edges of the bow approaching the patient’s central visual field
3. Estimate the extent of the peripheral vision
4. If you suspect loss in a visual field, test each eye by patient covering one eye, you cover your own eye opposite, then use one hand to wiggle along the imaginary bowl in that visual field– if you can see the wiggle, so should the patient.
5. Then repeat with the other eye