Manual
Clinical guide for the eye exam, emergencies and common workups
The Eye Exam
7 topicsA systematic 8-part exam
Visual acuityAlways first — the vital sign of the eye.Pupils & RAPDSize, shape, reactivity and the swinging-flashlight test.Ocular motility & alignmentH-pattern, cover tests and Hirschberg.Confrontation visual fieldsQuick screening for hemianopias and altitudinal loss.Intraocular pressureGoldmann, Tono-Pen and iCare.Slit lamp examFront-to-back anterior segment review.Dilated fundus examDisc, vessels, macula, periphery.Emergencies
8 topicsTime-critical presentations
Chemical injuryIrrigate first, examine later.Central retinal artery occlusionPainless sudden monocular vision loss = ocular stroke.Acute angle-closure crisisPainful red eye, halos, nausea, mid-dilated pupil.Open globe injuryShield, NPO, CT, antibiotics, OR.Orbital compartment syndromeRetrobulbar hemorrhage after trauma or surgery.Retinal detachmentFlashes, floaters, curtain.EndophthalmitisPost-operative or post-injection pain + vision loss.Giant cell arteritisArteritic AION — prevent fellow-eye blindness.The Red Eye
4 topicsBenign vs vision-threatening
Red eye differentialUse pain, vision, pupil and cornea to triage.ConjunctivitisViral, bacterial, allergic.Microbial keratitisCulture, then treat aggressively.Anterior uveitisPhotophobia, ciliary flush, cells & flare.Vision Loss
4 topicsSudden, transient and gradual
Sudden painless vision lossVascular, retinal, neuro.Transient monocular vision lossAmaurosis fugax is a TIA of the eye.Optic neuritisYoung adult, pain on eye movement, RAPD.Papilledema & IIHBilateral disc edema from raised ICP.Neuro-Ophthalmology
3 topicsPupils, palsies & diplopia
Horner syndromePtosis, miosis, ± anhidrosis.CN III, IV and VI palsiesWhich ones need emergent imaging?Approach to diplopiaMonocular vs binocular.Glaucoma
2 topicsDiagnosis and staging
Primary open-angle glaucomaChronic progressive optic neuropathy.Gonioscopy & angle gradingShaffer grading and landmarks.Retina
3 topicsDR, AMD, vein occlusion
Diabetic retinopathyScreening, grading and treatment.Age-related macular degenerationDry vs wet.Retinal vein occlusionCRVO vs BRVO.Pediatrics & Strabismus
4 topicsAmblyopia, ROP, leukocoria
AmblyopiaStrabismic, anisometropic, deprivation.LeukocoriaWhite pupil = retinoblastoma until proven otherwise.Retinopathy of prematurityScreening criteria and treatment.Childhood esotropiaInfantile vs accommodative.Quick Reference
2 topicsAbbreviations & normal values
AbbreviationsRead any ophthalmology note.Normal valuesNumbers worth memorising.