2.13 Complete Eye Exam

What to do:

• Visual acuity, using Snellen (wall) or Jaeger (hand-held) chart without then with the patients own corrective lenses. If glasses are not available, a pinhold will compensate for most refractory errors.
• Wearing gloves, inspect lids, conjunctivae, extraocular movements and pupillary reflexes.
• Use a 10x slit lamp to examine the cornea and anterior chamber, looking for any injection of ciliary vessels at the corneal limbus, indicating iritis. Look for light reflected from protein exudate or suspended white cells in the normally-clear aqueous humor when the slit lamp is stopped down to a pinhole (later signs of iritis). Look for red cells (hyphema) or white cells (hypopion) settling to the bottom of the anterior chamber after the patient has been sitting up for 15 minutes.
• Demonstrate the integrity of the corneal epithelium with fluorescein dye, which is taken up by exposed stroma or non-viable epithelium, and glows green in ultraviolet or cobalt blue light.
• Note the depth of the anterior chamber with tangential lighting