CLINICAL OPHTHALMOLOGY
(1) HISTORY
Demographic Data
• Name and address primarily required for pa ent’s iden ty
• Age and sex is required to note down and rule out par cular diseases
• Occupa on is useful in providing pa ent’s ocular health educa on, visual
rehabilita on and to know about ophthalmic manifesta ons due to occupa onal
hazards
• Religion helps in knowing the ap tude and prac ces prevalent in di erent
communi es
Chief Presen ng complaint
• Presen ng complaint should be recorded in chronological order with their dura on
History of presen ng illness
• Pa ent should be encouraged to narrate their complaint in detail and a note should
be made consis ng mainly the following points,
✓ Mode of onset and dura on
✓ Severity
✓ Progression
✓ Accompaniment of each symptoms
History of past Illness
• History of similar ocular complaints in the past (to know the recurrence)
• History of similar occurrence in the other eye
• History of any trauma to eye
• History of any ocular surgeries
• History of any systemic diseases
• History of drug intake and allergies
• History of Spectacle use
Kenedy Khatri
,Family History
(02). GENERAL PHYSICAL AND SYSTEMIC EXAMINATIONS
(03). OCULAR EXAMINATION
A. TESTING OF VISUAL ACUITY
• De ned as measurement of the threshold of discrimina on of spa ally separated
targets (the ability to dis nguish the shape of objects). In real sense acuity of vision is
re nal func on (macular area, fovea centalis) concerned with apprecia on of form of
sense. There should be an uns mulated foveal cone between s mulated cones to
allow for the resolu on of 2 targets and foveal cones are separated by 2µm to a
visual angle of
• Should be tested in all cases
• Distant and near visual acuity should be tested separately
DISTANT VISION
• Tests: Snellen’s Chart
Simple Picture chart (Children >2years)
Landolt’s C-chart (illiterate Pa ents)
E-Chart (illiterate Pa ents)
Basic Principle of Snellen’s test types,
The fact that 2 distant points can be visible as separate only when they subtend an angle of
1 minute at the nodal point of the eye. It consists of a series of black capital le ers on white
Kenedy Khatri
,board, arranged in lines, each progressively diminishing in size. The lines comprising the
le ers have such a breadth that they will subtend an angle of 1min at the nodal point.
Procedure,
1) Take Pa ent’s consent, make him/her seated comfortably at a distance of 6m
from the Snellen’s chart. (Make sure the chart is well illuminated, not less tha
20 candles)
Why 6m?
At 6m the rays of light are prac cally parallel (, distant <6m rays will be coming in divergent
fashion) and also the pa ent exerts minimum accommoda on. If there’s no space for 6m, it
can be achieved by placing a plane mirror at 3m and asking the pa ent to read the re ected
image in the mirror.
2) Ask the Pa ent to close the le eye with cupping hand
3) Point each le er from the top and ask the pa ent to read (If the pa ent can read
the rst line, then point the lines below un l the pa ent can read)
4) If the pa ent can’t read the rst line, make the pa ent move 1m front towards
the chart and make him read the rst line. (each me pa ent can’t read the rst
line, move 1m towards the chart ll the pa ent can read the top line)
Noted as VA= 6/6 (numerator= distance of pa ent from the chart, denominator= smallest
le er accurately read)
5) If pa ent unable to read the rst line at 1m, pa ent is asked to count ngers of
examiner (CF-3’, CF-2’, CF-1’/CF-close to face)
6) When pa ent fails to count ngers, examiner should move his hands close to the
pa ent’s face and ask whether the pa ent can appreciate the hand movements.
7) When the pa ent cannot dis nguish the hand movements, the examiner should
note whether the pa ent can perceive light or not
8) From the beginning everything MUST be done on right eye with pinhole
(size=1.25mm), with the pa ent’s glasses if he/she uses.
Kenedy Khatri
, 9) The same procedure should be done on the Le eye too.
Eg of a result,
Glasses,
PH
RE 6/18 6/9 6/6 P
VA P VA
PH
LE 6/6 X 6/6 P
Rules out: Re ni s Pigmentosa, Glaucoma, Tubular vision/ Tunnel vision
B. HEAD POSTURE
• Normally head is kept in an erect and straight posture without any lt of the head or
turn of face or eleva on/depression of chin or any other abnormal movement of the
head.
• There are 3 pairs of extraocular muscles, when the movement of eye is a ected
because of paralysis or paresis of these muscles head posture acts as a
compensatory mechanism to compensate for the restricted eye movements to avoid
diplopia.
✓ Face turn: Restricted horizontal movements are compensated.
Paralysis of rec muscles.
Eg. In Lateral Rectus Palsy, face turned to le
(eye deviated to right)
✓ Head Tilt: Restricted oblique movements are compensated.
Paralysis of oblique muscles.
Eg. Right Superior Oblique Palsy, head elevated and
lted to le
✓ Eleva on of chin: Restricted ver cal movements are
compensated.
Paralysis of Elevators (Superior Rectus and
Inferior oblique)
Overac on of depressors (Inferior Rectus and
Superior Oblique)
Ptosis ( 3rd CN Palsy)
✓ Depression of chin: Restricted ver cal movements are
compensated.
Paralysis of depressors (Inferior Rectus and
Superior Oblique)
Kenedy Khatri
(1) HISTORY
Demographic Data
• Name and address primarily required for pa ent’s iden ty
• Age and sex is required to note down and rule out par cular diseases
• Occupa on is useful in providing pa ent’s ocular health educa on, visual
rehabilita on and to know about ophthalmic manifesta ons due to occupa onal
hazards
• Religion helps in knowing the ap tude and prac ces prevalent in di erent
communi es
Chief Presen ng complaint
• Presen ng complaint should be recorded in chronological order with their dura on
History of presen ng illness
• Pa ent should be encouraged to narrate their complaint in detail and a note should
be made consis ng mainly the following points,
✓ Mode of onset and dura on
✓ Severity
✓ Progression
✓ Accompaniment of each symptoms
History of past Illness
• History of similar ocular complaints in the past (to know the recurrence)
• History of similar occurrence in the other eye
• History of any trauma to eye
• History of any ocular surgeries
• History of any systemic diseases
• History of drug intake and allergies
• History of Spectacle use
Kenedy Khatri
,Family History
(02). GENERAL PHYSICAL AND SYSTEMIC EXAMINATIONS
(03). OCULAR EXAMINATION
A. TESTING OF VISUAL ACUITY
• De ned as measurement of the threshold of discrimina on of spa ally separated
targets (the ability to dis nguish the shape of objects). In real sense acuity of vision is
re nal func on (macular area, fovea centalis) concerned with apprecia on of form of
sense. There should be an uns mulated foveal cone between s mulated cones to
allow for the resolu on of 2 targets and foveal cones are separated by 2µm to a
visual angle of
• Should be tested in all cases
• Distant and near visual acuity should be tested separately
DISTANT VISION
• Tests: Snellen’s Chart
Simple Picture chart (Children >2years)
Landolt’s C-chart (illiterate Pa ents)
E-Chart (illiterate Pa ents)
Basic Principle of Snellen’s test types,
The fact that 2 distant points can be visible as separate only when they subtend an angle of
1 minute at the nodal point of the eye. It consists of a series of black capital le ers on white
Kenedy Khatri
,board, arranged in lines, each progressively diminishing in size. The lines comprising the
le ers have such a breadth that they will subtend an angle of 1min at the nodal point.
Procedure,
1) Take Pa ent’s consent, make him/her seated comfortably at a distance of 6m
from the Snellen’s chart. (Make sure the chart is well illuminated, not less tha
20 candles)
Why 6m?
At 6m the rays of light are prac cally parallel (, distant <6m rays will be coming in divergent
fashion) and also the pa ent exerts minimum accommoda on. If there’s no space for 6m, it
can be achieved by placing a plane mirror at 3m and asking the pa ent to read the re ected
image in the mirror.
2) Ask the Pa ent to close the le eye with cupping hand
3) Point each le er from the top and ask the pa ent to read (If the pa ent can read
the rst line, then point the lines below un l the pa ent can read)
4) If the pa ent can’t read the rst line, make the pa ent move 1m front towards
the chart and make him read the rst line. (each me pa ent can’t read the rst
line, move 1m towards the chart ll the pa ent can read the top line)
Noted as VA= 6/6 (numerator= distance of pa ent from the chart, denominator= smallest
le er accurately read)
5) If pa ent unable to read the rst line at 1m, pa ent is asked to count ngers of
examiner (CF-3’, CF-2’, CF-1’/CF-close to face)
6) When pa ent fails to count ngers, examiner should move his hands close to the
pa ent’s face and ask whether the pa ent can appreciate the hand movements.
7) When the pa ent cannot dis nguish the hand movements, the examiner should
note whether the pa ent can perceive light or not
8) From the beginning everything MUST be done on right eye with pinhole
(size=1.25mm), with the pa ent’s glasses if he/she uses.
Kenedy Khatri
, 9) The same procedure should be done on the Le eye too.
Eg of a result,
Glasses,
PH
RE 6/18 6/9 6/6 P
VA P VA
PH
LE 6/6 X 6/6 P
Rules out: Re ni s Pigmentosa, Glaucoma, Tubular vision/ Tunnel vision
B. HEAD POSTURE
• Normally head is kept in an erect and straight posture without any lt of the head or
turn of face or eleva on/depression of chin or any other abnormal movement of the
head.
• There are 3 pairs of extraocular muscles, when the movement of eye is a ected
because of paralysis or paresis of these muscles head posture acts as a
compensatory mechanism to compensate for the restricted eye movements to avoid
diplopia.
✓ Face turn: Restricted horizontal movements are compensated.
Paralysis of rec muscles.
Eg. In Lateral Rectus Palsy, face turned to le
(eye deviated to right)
✓ Head Tilt: Restricted oblique movements are compensated.
Paralysis of oblique muscles.
Eg. Right Superior Oblique Palsy, head elevated and
lted to le
✓ Eleva on of chin: Restricted ver cal movements are
compensated.
Paralysis of Elevators (Superior Rectus and
Inferior oblique)
Overac on of depressors (Inferior Rectus and
Superior Oblique)
Ptosis ( 3rd CN Palsy)
✓ Depression of chin: Restricted ver cal movements are
compensated.
Paralysis of depressors (Inferior Rectus and
Superior Oblique)
Kenedy Khatri
