examination techniques
DESCRIPTION
Examination techniques. Lecture 4 Mutez Gharaibeh,MD. Start with inspection. Be friendly Toys Avoid white coats Behave as a child , think as a man. History. Why they are here Birth history Developmental history General health Family history. Symptoms. Red spot in the eye. - PowerPoint PPT PresentationTRANSCRIPT
Examination techniquesExamination techniques
Lecture 4 Lecture 4
Mutez Gharaibeh,MDMutez Gharaibeh,MD
Start with inspection.Start with inspection.
Be friendly Be friendly Toys Toys Avoid white coatsAvoid white coats
Behave as a child , think as a man Behave as a child , think as a man
HistoryHistory
Why they are here Why they are here Birth history Birth history Developmental history Developmental history General health General health Family history Family history
SymptomsSymptoms
Red spot in the eye Red spot in the eye
Squint Squint
Epiphora Epiphora
Rubbing his eyes Rubbing his eyes
Uncomfortable in bright light (photophobia)Uncomfortable in bright light (photophobia)
OthersOthers
Sits close to TV Sits close to TV Not good with colors Not good with colors Blinks a lot Blinks a lot HeadacheHeadacheAsthenopiaAsthenopia……. Etc . Etc
HeadacheHeadache
DiplopiaDiplopiaMonocular Vs BinocularMonocular Vs Binocular
Muscle Muscle Nerve Nerve Neuromuscular Neuromuscular Orbit Orbit Brain stem/BrainBrain stem/Brain
Refractive Refractive
ExaminationExamination
Visual acuity Visual acuity InspectionInspectionHirschburg test ( cornea light reflex)Hirschburg test ( cornea light reflex)Extraocular movements Extraocular movements Cover/ uncover testCover/ uncover testSlit lamp test Slit lamp test Pupils Pupils FundiFundiStereopsisStereopsis
Visual acuityVisual acuity<18 Mo<18 Mo
Response to occlusion Response to occlusion Hundreds and thousands ( > 6 mo)Hundreds and thousands ( > 6 mo)
CSMCSM
Central Steady MaintainedCentral Steady Maintained
UCUSUMUCUSUM
Visual acuity cardsVisual acuity cards
Forced choice preferential looking Forced choice preferential looking
The forced choice preferential lookingThe forced choice preferential looking
The forced choice preferential looking technique is very The forced choice preferential looking technique is very similar to the preferential looking technique, except that similar to the preferential looking technique, except that two or more stimuli are presented at the same timetwo or more stimuli are presented at the same time.. If the infant shows a preference for one stimulus over If the infant shows a preference for one stimulus over the otherthe other((ss)), the difference it and the others must be one , the difference it and the others must be one that they can seethat they can see.. For the researcher to know which differences the infant For the researcher to know which differences the infant is responding to, the stimuli should differ on only one is responding to, the stimuli should differ on only one dimensiondimension. . For example, if used to study developmental For example, if used to study developmental changes in contrast sensitivity, the stimuli should differ changes in contrast sensitivity, the stimuli should differ only in contrast and not other dimensions such as spatial only in contrast and not other dimensions such as spatial frequency or luminancefrequency or luminance..
Visual acuity cardsVisual acuity cards
Keeler acuity cardsKeeler acuity cards
Teller acuity cardsTeller acuity cards
Teller cardsTeller cards
High contrast ,black-White square grating High contrast ,black-White square grating patch on a uniform grey cards.patch on a uniform grey cards.Infants may appreciate the edge between Infants may appreciate the edge between the grating patch and the grey background the grating patch and the grey background ( overestimates visualacuity ).( overestimates visualacuity ).This is overcome by the Keeler cards.This is overcome by the Keeler cards.
Cardiff testCardiff test
> 12 Mo.> 12 Mo.
18-3618-36 MoMo
Acuity cards .Acuity cards .Cardiff card.Cardiff card.Kay pictures Kay pictures
Lea symbolsLea symbols
Sheridan-Gardiner testSheridan-Gardiner test
A,H,O,T,U,VA,H,O,T,U,V
3-53-5 yryr
Kay picture test Kay picture test Sheridan –Gardiner testSheridan –Gardiner test
> 5 r> 5 r …… …… Snellen charts / LogMAR charts … Snellen charts / LogMAR charts …
etc etc
RefractionRefraction
RetinoscopyRetinoscopy
Static retinoscopyStatic retinoscopy
Distance fixation retinoscopy.Distance fixation retinoscopy.
Cycloplegic refraction.Cycloplegic refraction.
Retinoscopy under sedation ( sleep).Retinoscopy under sedation ( sleep).
Near fixation retinoscopy( +/- Mohindra Near fixation retinoscopy( +/- Mohindra technique)technique)
Who should have cycloplegic Who should have cycloplegic refractionrefraction? ?
Poor fixators Poor fixators Any child with squint Any child with squint When you suspect accommodatino spasm When you suspect accommodatino spasm Variable dry refractino results Variable dry refractino results When dry refraction --- manifest refraction donot When dry refraction --- manifest refraction donot match match Newly diagnosed / rapidly increasing myopia Newly diagnosed / rapidly increasing myopia Follow up of hypermetroipa Follow up of hypermetroipa
Dilating dropsDilating drops
Near fixation retinoscopyNear fixation retinoscopy
Barret methodBarret methodDim lightDim lightUsually 67 cm working distance Usually 67 cm working distance A lens of equivalent diopteric power in A lens of equivalent diopteric power in front of each eyefront of each eyeFocus on featureless objectsFocus on featureless objectsFog nonexamined eyeFog nonexamined eye
PMTPMT
Subjective refraction is rarely possible < 5 Subjective refraction is rarely possible < 5 yr of age .yr of age .Guessing Guessing Short attention spanShort attention span
Continue your examContinue your exam
Next time Next time