1. In the name of god Clinical eye examination Hamid Fesharaki MD Eye department Isfahan University of medical sciences History & physical examination

2. Clinical eye examination History & physical examination

3. Hand Held Acuity Card Ophthalmic symptoms : pain, redness, itching, burning, F B sensation, Visual loss Snellen Chart

4. Physical examination visual acuity: fixation & follow, snellen chart

5. Clinical examination Visual acuity: central, peripheral visual acuity is hard to check due to its subjective nature: depends on the response of the patient (intelligence, previous experience, alertness)

6. Measurment of visual acuity monocular vs binocular, wit or without correction far and near

7. Accurate clinical eye examination reduces the para clinical expensive testing Poor ophthalmoscopy may call for ocular sonography, OCT, FA… Define the best corrected visual acuity first Refraction is the beginning step of clinical examination clinical judgment without refraction can be miss guiding RAPD (Retrobulbar neuritis) Judgment by observation alone may be misleading A relatively pale optic disc Reduced light reflex of fovea Optometrist referral for retinal problem

8. Refractive error: retinoscopy, subjective refraction including the pin hole, autorefraction.

9. subjective refraction To find the best corrected visual acuity

10. Autorefrctor may give wrong numbers

11. Biomicroscopy

12. Direct ophthalmoscope

13. Observation of the fundus structures is very important for clinical diagnosis.

16. Visual loss: 1. Refractive error: retinoscopy, subjective refraction including the pin hole, autorefraction. (Irregular astigmatism) 2. Opacity of media: ophthalmoscopy, retinoscopy, biomicroscopy. (red reflex) 3. Retina & Optic nerve : ophthalmoscopic observation, RAPD, visual field, ERG, EOG, VEP, angiography, OCT, ultrasonography. (Amblyopia) Amblyopia: history & phsical: Anisometropia, Isoametropia, Strabismic, (Monofixation synd) 4 prism base out test Malingering: age, gain, tricks Legal writing Beyond the optic nerve: RAPD,VEP, Visual field, brain imaging Deprivation

17. Refractive error Irregular astigmatism

18. . Opacity of media: ophthalmoscopy, retinoscopy, biomicroscopy. ultrasonography (red reflex)

19. Evaluation of retina & optic nerve Visual field: Confrontation, tangent screen

20. Visual field: Static & kinetic perimetry

22. Evaluation of retina & optic nerve Observation: Compare between the two eyes, and compare with the population. Correlate between BCVA, clarity of visual pathway and fundascopic findings Relative afferent pupillary defect Function tests: visual field,VEP, ERG, EOG..

23. Retina & Optic nerve : Angiography, visual field, OCT, GDX, ERG, EOG, VEP, ultrasonography,

24. Beyond the optic nerve: Visual field brain imaging: MRI, CTscan

25. visual field

29. The pattern of visual field may be diagnostic

34. Snellen Chart For Acuity Testing

35. Checking Visual Fields By Confrontation

37. Left eye cannot move laterally

39. Observation External Structures Pupil, iris and eyelids & lashes should appear symmetric Sclera should be white Conjunctiva clear