5
Ocular Examination
e comprehensive eye examination consists of an evaluation of the physiological
function and the anatomical status of the eye, visual system, and its related structures.
is usually includes the following elements:
• Visual acuity with current correction (the power of the present correction recorded) at
distance and, when appropriate, at near, with a refraction when indicated
• Visual fields by confrontation
• External examination (e.g., eyelid position and character, lashes, lacrimal apparatus and
tear function; globe position; and pertinent facial features)
• Pupillary function (e.g., size and response to light, relative afferent pupillary defect)
• Ocular alignment and motility (e.g., cover/uncover test, alternate cover test, version
and duction assessment)
• Slit-lamp biomicroscopic examination: eyelid margins and lashes; tear film;
conjunctiva; sclera; cornea; anterior chamber; and assessment of central and peripheral
anterior chamber depth, iris, lens, and anterior vitreous
• Intraocular pressure measurement, preferably with a contact applanation method
(typically a Goldmann tonometer). Contact tonometry may be deferred in the setting
of suspected ocular infection or corneal trauma
• Fundus examination: mid- and posterior vitreous, retina (including posterior pole and
periphery), vasculature, and optic nerve
• Assessment of relevant aspects of patient's mental and physical status
Specialized clinical evaluation may include the following:
• Monocular near-vision testing
• Potential acuity testing
• Glare testing
• Contrast sensitivity testing
• Color-vision testing
• Testing of stereoacuity and fusion
• Testing of accommodation and convergence amplitudes
• Central visual field testing (Amsler grid)
• Expanded evaluation of ocular motility and alignment in multiple fields of gaze at
distance and near
• Exophthalmometry (e.g., Hertel)
• Tear breakup time
