basic of ophthalmology examinations
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BASIC OF
OPHTHALMOLOGY
EXAMINATIONS
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Ophthalmology examinations
1. General eye examinations :
– Anamnesis
– Physical of eye exam
– Visual function evaluation
2. Specific eye examinations
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ANAMNESIS
• Purpose : to pursue the eye diseases
history
• two methods: : – Autoanamnesis (directly to the patients
Cooperative)
– Alloanamnesis (Family of the patients
non cooperative)
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The collected informations : :
1. General : Identites (name, age, gender,address, job, and so on)
2. Specifics :
a. Chief of complain : blurred of vision,dyplopia, pain,irritatif, red eye, trauma
b. Other of clinical signs link to the maincomplain : onset, progressitivity, duration,
reversibility, lacrimation, disturbance of eyemotility, histrory of trauma, glasses, systemicdiseases (DM, HT), and so on
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Physical of eye exam
1. Inspection anterior segment of eye ball
2. Oblique illumination anterior segment of eye ball
3. Palpation finger tension
pain pressure (uveitis)
Tumor mass
adenopathy (Preaurikuler gland)
4. Visus
5. Refraction
6. Intra ocular pressure
7. Visual field
8. Ophthalmoscopy
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1. Inspection• No equipment
• Examiner directly observe the eye (good
illumination room)
• The evaluated structures : – Eyelid : supercilia, cilia, skin, fissura, plica, canthus,
conjunctiva (eyelid eversion) comparing the right
and left eyes
– Anterior segment of the eye :
1.Conjunctiva: injeksio, redness,chemosis,bleeding,
laseration, foreign bodies.
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• Sclera : color, thickness, or trauma
• Cornea : diameter, curvature, intact (trauma).
• Anterior chamber : contents, deep or shallow.
• Iris : color, vasculature, crypte
• Pupil : Form, position, color, margin, number
• Lens : transparancy, position (trauma)
• Eye movements
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2. Oblique Illumination
• Equipments : pen light
• Technique ? :
• What are the visible structures : more detail thaninspection ?
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Oblique illuminationsThe evaluated structures :
1. Eye lid : (= inspection)
2. Anterior segment : clearer the inspection
a. Cornea : cikatriks nebula, small foreign body,
blood stainb. Iris : kripte, sinekia
c. Anterior chamber : contents (hyphema,hypopion)
d. Pupil : direct/ indirect pupil reflex,regularitasity pupil margin
e. Lens : iris shadow & pseudo iris shadow
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Myosis Mydriasis
Light reflex in the pupil
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Anatomy
Physiology
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3. PalpationNo equpments, only the finger
1. Tumor mass
2. Palpable of pre auriculer gland
3. Pain pressure (iridocyclitis/uveitis)
4. Finger tension (high of IOP)
Pen light evaluate : :
• Hirschberg test (strabismus)
• Light perception test (visus = 1/)
• Light projection test (retinal function)
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Tumor mass : consistency, pain pressure,pulsation +.
Palpable of pre auriculer gland - Cancer spreading
- Viral infection of the eye
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Palpation for IOP : Technique ?
CSL …………. Spesial sense system !
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• Results : 5 category :
Tn ……….. Normal IOP
Tn – 1 …… Low of IOP
Tn – 2 . …..Very low of IOP
Tn + 1……. High of IOP
Tn + 2……. Very high of IOP
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4. Intra ocular pressure evaluations
Direct & Indirect methods
Direct :
• Introducing canula to anterior chamber and
link to manmeter.• For animal study and experiment
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Inderect : 2 methodes :
1. finger tension
2. Tonometer : contact and non contact.
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Tonometri
Tonometer Schiotz
Tehnique : CSL of Special Sense system !
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Hasil Pemeriksaan
Ditulis dalam bentuk 2 angka
• Angka pecahan (tanpa satuan) : sebagai
pembilang adalah skala dan beban sebagai penyebut.
• Angka desimal : dapat diperoleh pada
tabel yang ada pada tonometer dengancara menarik garis hayal horisontal.
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5. Visual field (VF) testing
Purpose : to determine the peripheral visual field
Normal VF : Nasal/Medial field = 60 0
Temporal field = 90 0
Superior field = 70 0
Inferior field = 50 0
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VF defects contribute to :
a. Diseases dignosis
b. Locations of lesions in retina, visualcortex area in the brain
Examination tests :
1. Confrontaion test (CSL special sense)
2. Amsler grid3. Perimetri (Goldman VF testing
4. Tangent Screen (campimeter)
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7. Visual evaluations
Visual Acuity: the ability of the eye to percept the
detail and clear objects.Classification : based on reading distance :
1. Distance visual test : reading distance > 20
feet (5 meter)
2. Intermediate visual test
3. Near visual test : reading distance (1/3 meter)
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Distance visual testing
Sinonim : Central visual testing
Equipments:1. Reading chart
a. Snellen chart (alphabet or numbering)
b. E chart (E)c. Allen chart (easy picture)
2. Reading distance 5 or 6 meter
3.Optimal room illumination
Technique ? CSL
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Reading-object shifting :
1. Counting Finger (CF) ;
………reading value : 60
2. Hand movement/hand motion (HM) ;
……….reading value 300
3. Light perception (LP) ;
………..reading value (unlimited value)
4. No light perception : visus = 0
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Visual testing results :
- 5/40, 1/60, 1/300 and so on- 1,0 ; 0,5 ; 0,1
Ex: VOD : 1/60 = Visual acuity of the right eye isthe ability of patient to only see object at 1 meter
while the normal individual can see in 60 meter.
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8. Refraction test
• To indentify the refraction errors : Myopia,
Hyperopia, astigmatism
• Eq. : Snellen Chart & Trial Lenses
• Therapy : glasses, contact lens, LASIK
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9 P t i t i ti ???
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9. Posterior segment examinationa ???
Eq.: = Funduscopy/ ophthalmoscopy
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RETINA
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Ophthalmology scopes :
1. REFRACTION
2. LENS AND CATARACT
3. VITREO-RETINA
4. EXTERNAL EYE DISEASES (EED)5. TUMOR OF THE EYE
6. TRAUMA DAN RECONSTRUCTION
7. PEDIATRIC AND STRABISMUS
8. NEUROOPHTHALMOLOGY9. SOCIAL OPHTHALMOLOGI
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EYE DISEASES SYMPTOMS
1. RED EYES
2. BLINDNESS
3. Abnormal Structures and positions
4. TRAUMA
5. Systemic and eye syndrome
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RED EYE
•
RED EYE WITH IMPAIR/DECREASE OFVISUAL ACUITY
Ex. : Uveitis, Keratitis, acute glaucoma, trauma
• RED EYE WITH NORMAL VISUAL ACUITY
Ex. : conjunctivitis, Episcleritis, Pterygium
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BLINDNESS
•SUDDEN BLINDNESS (SUDDEN VISUALLOSS)
Ex. : Retinal detachment, neuritis, vitreous bleeding
• CHRONIC VISUAL LOSS
Ex. : cataract, non acute glaucoma, retinitis pigmentosarefraction errors (=myopia, hyperopia, astigmatism)
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Abnormal Structures and positions
• Eyelid : ptosis, ectropion, intropion dll.
•Eye ball : strabismus
• Structure : microphtalmia, keratoconus, bulls eye.
•
Proptosis: extra and intraokuler mass
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TRAUMA
• PERFORANS TRAUMA
• NON- PERFORANS TRAUMA
(BLUNT TRAUMA)
• CHEMICAL TRAUMA (ACID OR
ALKALI
• FOREIGN BODIES OF THE EYE BALL
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