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Clinical eye examination History & physical examination

In the name of god Clinical eye examination Hamid Fesharaki MD Eye department Isfahan University of medical sciences History & physical examination. Clinical eye examination History & physical examination. Ophthalmic symptoms : pain, redness, itching, burning , F B sensation, Visual loss.

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Clinical eye examination History & physical examination

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  1. In the name of god Clinical eye examinationHamid Fesharaki MDEye department Isfahan University of medical sciences History & physical examination

  2. Clinical eye examinationHistory & physical examination

  3. Ophthalmic symptoms : pain, redness, itching, burning , F B sensation, Visual loss Clinical eye examinationHistory & physical examination Snellen Chart Hand Held Acuity Card

  4. Physical examinationvisual 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 acuitymonocular vs binocular, wit or without correctionfar and near

  7. Accurate clinical eye examinationreduces the para clinical expensive testingPoor ophthalmoscopy may call for ocular sonography, OCT, FA…Define the best corrected visual acuity firstRefraction 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.

  14. 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, tricksLegal writing Beyond the optic nerve: RAPD,VEP,Visual field, brain imaging Deprivation

  15. Refractive error Irregular astigmatism

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

  17. Evaluation of retina & optic nerveVisual field: Confrontation, tangent screen

  18. Visual field: Static & kinetic perimetry

  19. Visual field: Static & kinetic perimetry

  20. 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..

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

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

  23. visual field

  24. The pattern of visual field may be diagnostic

  25. Snellen Chart For Acuity Testing

  26. Checking Visual Fields By Confrontation

  27. Left eye cannot move laterally

  28. Observation External StructuresPupil, iris and eyelids & lashes should appear symmetricSclera should be whiteConjunctiva clear

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