1. Eye care basics and optical options
Rick Smith
&
Sam Powdrill

2. Eye Anatomy

3. Visual Image

4. Components of Vision

5. The External Eye

6. The Skull

7. Bones of the Orbit
Frontal
Zygoma
Ethmoid
Maxilla
Sphenoid

8. The Lacrimal System The tear film Lipid layer Aqueous layer
Mucus layer

9. The Eyelids

10. Vessels and Muscles of the Eyelids

11. Extrinsic Eye Muscles

12. Extrinsic muscles with innervation

13. The Globe Anterior chamber aqueous Iris Lens
Posterior chamber vitreous
Optic nerve

14. Layers of the eye
Protective
Vascular
Visual

15. Protective Layer
Sclera
Cornea

16. Vascular layer
Iris
Ciliary body
Choroid

17. Angle of the Eye

18. Visual Layer
The retina
Optic nerve

19. Central Retina

20. Optic Nerve (II) Visual pathway

21. Optic Nerve (II) – Visual pathway

22. Refraction

23. Prism

24. Converging

25. diverging

26. Lens Power Measured in diopters One diopter lens focuses at 1 meter
Lens power = cm
focal length
focal length = cm
Lens power

27. Refractive errors Nearsighted – myopia Farsighted – hyperopia
Astigmatism
Presbyopia

28. Refraction
Convex lens
Concave lens
Accommodation
Refractive error

29. Correction of Refractive Errors
Pinhole
Myopia
Hypermetropia
Astigmatism

30. Exam of the Eye

31. Eye Exam

32. Pathways of Blindness Corneal Anterior chamber Lens Vitreous Retina
Optic nerve
Occipital
Functional

33. Instruments needed to examine the eye
Visual acuity chart
Flashlight
Ophthalmoscope
Tonometer
Simple loupe

34. The vital sign of the eye
Measure Visual acuity
The vital sign of the eye
Distance vision
Near vision
Peripheral vision
Central vision
Color vision

35. Snellen charts

36. Pinhole eliminates the refractive error

37. Visual acuity Cover the eye with the palm of the hand
Test the eyes separately then together
Point to the letters clearly
Use a random sequence

38. Recording Visual acuity
20/20
Upper number = distance in feet from the patient to the chart
Lower number = distance in feet at which a person with excellent vision would see the same letter

39. Examples
20/40
20 /400
20/15
10/50
CF 10ft HM LP
NLP

40. Central vision Test for loss of central vision - macula Amsler grid
Abnormal in macular degeneration

41. Amsler grid

42. Color vision Check for red / green color blindness Ishihara chart
Color comparison method with a red object
Color blindness is an X linked genetic disorder that most often affects males.

43. Ishihara chart

44. Tonometry
Schiotz
Applanation
Air puff
tonopen
Normal is
10 to 20 mmHg

45. Extraocular Muscles Six Cardinal eye movements
Corneal light reflex position
Nystagmus
Cover - uncover test
Convergence

47. Testing the visual field
Peripheral vision
Testing the visual field
Confrontation method – compares the examiner’s visual field with the patient’s
Automated – done in optometrist’s or ophthalmologist’s office
Abnormal in glaucoma

48. Visual fields by confrontation

49. Eyelids Inspect Symmetry – skin creases Opening and closing completely
Eyelash position
Ptosis
Tremor or fasciculations
Swelling or infection
Flakiness

50. cataract
Ophthlmoscope set on +4
Shadows against Red reflex

51. Direct light vs Coaxial light on the lens

52. Eyelids Palpate Eyelids for nodules Intraocular pressure
Evert upper and lower lids and inspect
Color
Discharge
Lacrimal system

53. Conjunctiva and Sclera
Inspect
Redness
Vessels
Growths or lesions, foreign bodies
Proptosis
enophthalmos

54. Cornea Inspect Clarity – scars obscure part of the iris.
Light reflex – reflex is scattered in edema
Corneal sensitivity
Arcus
Depth of anterior chamber – iris shadow
Abrasions or foreign bodies – use fluorescein stain with blue light to examine the cornea for defects

55. Iris and pupil Inspect Iris Color Angle lesions Inspect Pupil Size
Shape
Reaction to light
Reaction to near
Consensual response
PERRLA

56. Ophthalmoscope exam Lens clarity – lens opacity is a cataract
Red reflex – ophthlmoscope set on + 4
Vitreous clarity – floaters, sclerotic bands
Retinal color and background
Retinal vessels – hemhorrage, cotton wool spots, AV nicking, neovascularization,
Optic disc – cup/disc ratio
Optic nerve head – papilledema, cupping or atrophy
Macula for drusen or changes

57. Retina

58. Retina

59. Retina

60. Retina