basic examination of the eye

BASIC EXAMINATION OF THE EYE

By: Yohanes SilihI11107004

TOPICS

• EXAMINATIONS OF CORNEA• EXAMINATIONS OF UVEA• EXAMINATION OF LENS• EXAMINATION OF ORBITA• EXAMINATION SOF RETINA

EXAMINATIONS OF CORNEA

• Pachymetry• Plasidiscope Test• Cornea Reflex• Fluoresein• Rose Bengal• Metilen Blue

Pachymetry

• Corneal pachymetry is the measurement of corneal thickness.

• There are two pachymetr y techniques:– Optical pachymetry with a slit lamp and measuring

attachment may be performed on the sitting patient.

– Ultrasonic pachymetry; this has the advantage of greater precision and can also be performed with the patient supine.

Plasidiscope Test• Device: plasidiscope board with concentric black and white

circle.• Technique:

– Source of Light behind patient– Plasidoscope as high as eyes of patient– See through space in the middle of plasidoscope picture of patient

cornea.• Interpretation:

– Concentric shadow normal cornea– Oval concentric lines astigmatism– Unregulated concentric lines irreguler astigmatism– Unclear lines unclear cornea or edema of cornea

Cornea Reflex/ Cornea Sensibility/Wink Reflex

• Aim:Trigeminal nerve function test.• Technique:– Ask patient to look contrary side of examined cornea.– Hold patient eyelid using thumb and index finger.– Cotton patched to cornea surface– See present of patient wink reflex, pain, and lacrimation

• There is wink reflex good sensibility• Wink reflex decrese to patient with keratitis, herpes

simplex ulcer

Fluoresein Test

• Aim: To know damage of cornea epitel using fluoresein.• Basic:Fluoresein become green when patched to

damage cornea epitel alkali.• Material: fluoresien 0,5-2 % and patocain drop• Technique:

– The eye dropped with pantocain– Fluoresein dropped to the eyes– Irigate with physiologic salt– Examine the cornea

• Green colors of cornea defect of cornea epitel

Rose Bengal

• Aim: Its sodium salt commonly used in eye drops to stain damaged conjunctival and corneal cells and thereby identify damage to the eye.

• Basic: Rose bengal will make red coloration to death cell.• Material: rose bengal 1 % and local anesthesia eye drop.• Technique:

– Eye anesthesia– Rose bengal dropped to superior limbus.– Irigate with physiologic salt.

• Red coloration of cornea or conjungtiva cells death

Metilen Blue

• Aim:To know defect of cornea nerves.• Basic: Metilen blue staning damaged cornea nerves tip.• Materials: metilen blue, 5% and Topical anesthesia• Technique:

– Give eye topical anesthesia– Dropped 0,5 % methylen blue 3 times every 5 minutes.– See coloration of cornea

• Interpretation: blue coloration of cornea damage of cornea nerves tip.

EXAMINATION OF UVEAPilokarpin 1 % Test• Aim: To ensure cause of midriatic of pupil: compulsion or

fault salving (drugs) application .• Basic: pilokarpin make miosis to midriatic eyes cause of pupil

contusio/trauma but can’t make miosis to midriatic eyes cause of drug application.

• Material: pilokarpin 1 %• Technique: give pilokarpin to midriatic eyes and wait during 2

hours.• Interpretation: midriatic pupil miosis (+) = compulsion

midriatic pupil miosis (-) = midriatic drug

EXAMINATION OF LENSShadow Test• Aim: to know degree of lens turbidity• Basic: more turbid of lens will make bigger shadow of iris.• Devices: sentolope lamp and loupe.• Technique:

– irradiate pupil using sentolop on 45 degree of iris.– Using loupe, looking at shadow of iris to the lens.

• Interpretation:– Shadow test (+): big shadow of iris and far to pupil a half turbidity– Shadow test (-): small shadow of iris and near to pupil total

turbidity

EXAMINATION OF ORBITA

Eksolftalmometry• Aim: to measure protrusion of orbita.• Device: Hertel exophthalmometer.• Normal protrusion: 12-20 mm or difference

protrusion between both eyes less than 2 mm.

EXAMINATIONS OF RETINA

• Oftalmoscope / Funduscope• Red reflex• Projection Test• Ishihara• Confrontation Test• Electroretinography (ERG)

Ophthalmoscopy/Funduscopy• Aim: evaluate condition or abnormalities of

fundus.• Basic: light to the fundus will showing reflex

fundus picture of fundus.• There are two type: indirect and direct

Ophthalmoscopy.

• Device: oftalmoscope and drug for dilatation of pupil (mydriacyl).

• Technique: – Examine in dark room!– Prinsiple: right with right, left with left.– First, use +12.00 D of optalmoscope.– Opthalmoscope is about 10 cm from patient eye.– Move the opthalmoscope approach the eye and change the

lenticular force approach 0 D.– Light focus to the papil of optic nerve.– Evaluate all part of retina

• Find:– Papil of optic nerve

• Papiledema• Atropy of optic nerve• Lost of vein pulsation of optic nerve

– Retina • Subhialoid hemorrage• Intraretina hemorrage• Edema of retina• Edema of macula

– Retina vascularisation• Artery-vein rasio• Mikroaneurism of vein

Red Reflex

• Aim: to evaluate clearness of visual axis.• Technique: – Dark room.– Irradiate patient eyes with opthalmoscope in 12-18 inch,

irradiate both of the eyes alternately.– Evaluate present of red reflex.

• Interpretation:– Normal red reflex– Abnormal white reflex, red reflex (-), turbidity, dark

spot.

Projection Test

• Aim: to know the function of peripheral retinal• Basic: normal retina can recognize the light into the eye.• Device: sentolope• Technique:

– Dark room.– Patients were asked to close one eye that is not checked– open eyes illuminated from four directions, and ask where

the direction of the light.• Interpretation: if patient know the direction of

lightnormal peripheral retina function

Confrontation Test• Aim: to know abnormalies of visual field.• Basic: comparing patients visual field with examiner visual field.• Technique:

– Distance between patient and examiner is about 1 metre.– Closed left eyes examiner following with closed left eyes of patient.– an object is placed between the patient premises examiner at the same distance.– objects began to move from peripheral to central direction, till seen by examiner.– if the object seen by the examiner then asked if the object has been seen by the

patient– did in all directions and the other eye patients

• Interpretation:– Normal: patients see objects when examiner also see it

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