Eye Examination

Introductions

  • Rapport with patient
  • Sit on edge of bed □

General Inspection

  • Diagnostic facies
  • Ptosis
  • Conjunctiva
  • Cornea
  • Sclera
  • Pupil Asymmetry
  • Xanthelasma
  • Eye Patch
  • Bruising
  • Hearing Aid

Inspect from above & behind

  • Exopthalmos

Return to front

Test Lid Lag & Fatigability

Test Visual Acuity with Snellen chart

  • Left Eye
  • Right Eye

Test Visual Fields

  • Left Eye
  • Right Eye

Test Light Reflexes

  • Direct
  • Consensual
  • Swinging torch test

Test Accomodation

  • Hat Pin

Perform Fundoscopy (Beware the glass eye!)

  • Cornea
  • Lens
  • Vitreous
  • Optic Disc
  • Retinopathy

Test Ocular Movement (If diplopia occurs test each eye individually)

  • Dysconjugate gaze (MLF)
  • H pattern testing
  • Diplopia
  • Test Intorsion (if CN III palsy)

Test for Nystagmus

  • Vertical Horizontal
  • Gaze fixation
  • Frenzel lenses

Test Corneal Reflex

  • CN V1
  • CN VII

Palpate Orbits

  • Step deformity
  • Tenderness

Listen for Ocular Bruit

  • Left eye
  • Right eye

Test for Horner’s Syndrome

  • Palpation of brow for anhidrosis

Test for Lateral Medullary Sydnrome

  • Ipsilateral
    • V:
      • Facial Pain &
      • Temperature
    • VIII:
      • Central Nystagmus
      • Hearing
    • IX & X:
      • Dysphonia
      • Swallowing
      • Cough
      • Uvula deviation
      • Gag reflex
      • Cerebellar function
  • Contralateral
    • Trunk & Limbs Pain & Temperature

Test for C8/T1 lesion

  • Finger abduction weakness Clubbing

Examine for Neck Causes of Horner’s

  • Lymphadenopathy Thyroid Masses
  • Carotid Aneurysm

Test for spinal cord causes of Horner’s

  • Syringomyelia
  • Dissociative sensory loss

Ask for BSL

Summary & Interpretation

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