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Eye examination(2)
Author: fishallon   Add date: 08/23/2008   Publishing date: 08/23/2008   Hits: 5
Total 3 pages, Current page:2, Jump to page:
 

If there is a unilateral small pupil with normal reactivity to light, it is unlikely that a neuropathy is present. However, if accompanied by ptosis of the upper eyelid, this may indicate Horner's syndrome.

If there is a small, irregular pupil that constricts poorly to light, but normally to accommodation, this is an Argyll Robertson pupil.

 

Ocular motility

Main article: Extraocular muscles

Ocular motility should always be tested, especially when patients complain of double vision or physicians suspect neurologic disease. First, the doctor should visually assess the eyes for deviations that could result from strabismus, extraocular muscle dysfunction, or palsy of the cranial nerves innervating the extraocular muscles. Saccades are assessed by having the patient move his or her eye quickly to a target at the far right, left, top and bottom. This tests for saccadic dysfunction whereupon poor ability of the eyes to "jump" from one place to another may impinge on reading ability and other skills.

Slow tracking, or "pursuits" are assessed by the 'follow my finger' test, in which the examiner's finger traces an imaginary "double-H", which touches upon the eight fields of gaze. These test the inferior, superior, lateral and medial rectus muscles of the eye, as well as the superior and inferior oblique muscles.

 

Visual field (confrontation) testing

Main article: Visual field
Main article: Visual field test

Evaluation of the visual fields should never be omitted from the basic eye examination. Testing the visual fields consists of confrontation field testing in which each eye is tested separately to assess the extent of the peripheral field. To perform the test, the individual occludes one eye while fixated on the examiner's eye with the non-occluded eye. The patient is then asked to count the number of fingers that are briefly flashed in each of the four quadrants. This method is preferred to the wiggly finger test that was historically used because it represents a rapid and efficient way of answering the same question: is the peripheral visual field affected?

Common problems of the visual field include scotoma (area of reduced vision), hemianopia (half of visual field lost), homonymous quadrantanopia (involving both eyes) and bitemporal hemianopia.

 

Intraocular pressure

Intraocular pressure can be measured by any of a series of devices designed to measure the outflow (and resistance to outflow) of the aqueous humour from the eye.

 

Ophthalmoscopy

Ophthalmoscopic examination may include visually magnified inspection of the internal eye structures and also assessment of the quality of the eye's red reflex.

Ophthalmoscopy allows the one to look directly at the retina and other tissue at the back of the eye. This is best done after the pupil has been dilated with eye drops. A limited view can be obtained through an undilated pupil, in which case best results are obtained with the room darkened and the patient looking towards the far corner.

The appearance of the optic disc and retinal vasculature are the main focus of examination during ophthalmoscopy. Anomalies in the appearance of these internal ocular structures may indicate eye disease or condition.

 

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