Summary![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
The evaluation of the eyes is an essential component of the physical examination. There are two types of eye examinations, basic and comprehensive. This article focuses on the comprehensive eye examination, a series of at least twelve tests to screen and diagnose common eye disorders. It should be performed on patients with ophthalmologic symptoms and annually on all individuals ≥ 40 years of age. Tests typically include evaluation of visual acuity, visual fields, the external eye structure (orbit, eyebrows, eyelids and margins, palpebral aperture, lacrimal apparatus, conjunctiva, sclera, cornea), the anterior ocular chamber (iris, lens, pupils), ocular movements, and the optic fundus. Adjunct tests and procedures may be indicated depending on the findings of the initial exam.
For more information on the basic eye examination, see “Head and neck examination.”
Overview of the comprehensive eye examination![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
The comprehensive eye examination screens and diagnoses common eye disorders; it consists of at least twelve tests. [1]
- Complete family and medical history
- Family history: history of glaucoma, history of cataracts
- Medical history: chronic eye conditions, diabetes mellitus, hypertension
- Visual acuity test: performed using a Snellen chart, E chart, or Landolt ring chart
- External eye examination: performed using a penlight or slit lamp
- Refraction (automated refraction)
- Color vision test (Ishihara test)
-
Ocular movement examination
- Examination of the movements and alignment of the eyes
- Cover tests
- Visual fields examination (confrontation test)
- Pupillary examination: morphology and reflexes
-
Slit lamp biomicroscopy examination
- Eyelid eversion
- Lacrimal apparatus examination (tear break-out time)
- Gonioscopy
- Intraocular pressure examination: performed using a tonometer
- Fundoscopic examination: performed using an ophthalmoscope or slit lamp
- Retinal examinations (fluorescein angiography, OCT, electroretinogram, EOG)
- Schirmer test
Visual acuity![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: an ophthalmological examination used to determine the clarity or sharpness of central vision at various distances
-
Indications
- Routine ophthalmological examination
- Suspicion of refractive errors
- Changes in vision
- Post cataract surgery
-
Types of visual acuity [2]
- Minimum detectable acuity (determines if an object is present or not)
- Minimum separable acuity (identification of separation between two objects)
- Minimum recognizable acuity (identification of the smallest characteristic of an object)
- Minimum discriminable acuity (identification of changes in size, position, or orientation of an object)
-
Visual acuity tests
-
Snellen chart
- An ophthalmological chart that displays several rows of capital letters of different sizes
- Used to evaluate visual acuity
-
E chart
- An ophthalmological chart that displays several rows of the letter “E” in different sizes and rotations
- Used to evaluate visual acuity
-
Landolt ring
- An ophthalmological chart that displays several rows of a ring with a gap (resembles the letter “C”) in different sizes and rotations
- Used to evaluate visual acuity [2]
-
Snellen chart
-
Procedure
- Position the examinee at a predetermined distance from the chart (usually 20 feet/6 meters).
- Ask the examinee to cover one eye and consecutively read the designated chart, beginning with the smallest row that can be read.
- Snellen chart: The examinee reads the rows of letters out loud.
- E chart: The examinee points or states in the direction that the “legs” of the letter E are pointing (up, down, left, or right).
- Landolt ring: The examinee points or states in the direction that the gap in the ring is pointing (up, down, left, or right).
- Normal findings: emmetropia (20/20 vision)
- Abnormal findings
-
Clinical significance
- Refractive errors (myopia, hyperopia, presbyopia, astigmatism)
- Visual pathway lesion (e.g., bitemporal hemianopsia)
- Blindness
External eye examination![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: an ophthalmological examination in which the external eye structures (orbit, eyelid, eyelashes, lacrimal system, conjunctiva) are assessed
- Indications
- Procedure
-
Clinical significance
-
Orbit
- Inflammation (cellulitis)
- Trauma (ecchymosis)
- Dermatological abnormalities (herpes zoster ophthalmicus)
-
Lacrimal system
- Excessive tearing (epiphora)
- Tear deficiency (dry eyes, keratitis sicca)
- Inflammation (dacryocystitis, dacryoadenitis)
- Masses
- Eyelashes
- Abnormal position (trichiasis)
- Inflammation (madarosis, blepharitis)
- Eyelids
- Abnormal shape and position (ptosis)
- Abnormal motility (lagophthalmos, proptosis)
- Abnormal eyelid margin (entropion, ectropion)
- Swelling of the eyelid margins (blepharitis, chalazion, mass)
-
Palpebral aperture
- Normal aperture: 28–30 mm
- Abnormal aperture (enophthalmos, blepharospasm, lid retraction)
-
Conjunctiva
- Abnormal color
- Conjunctival injection: a physical finding of eye redness due to vasodilatation of conjunctival vessels
- Ciliary injection: a physical finding of eye redness due to vasodilation around the cornea
- Mixed injection: a combination of conjunctival and ciliary injection
- Secretions (bacterial conjunctivitis)
- Papilla and follicle abnormalities (giant papillary conjunctivitis)
- Abnormal color
-
Orbit
Refraction![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: an ophthalmological examination performed to determine the ability of the eyes to focus
-
Indications [3]
- Routine ophthalmological examination: determine the type and amount of refractive error
- Blurred vision
- Age ≥ 60 years
- Chronic diseases (i.e., hypertension, diabetes mellitus)
-
Types of exam [3]
- Objective (using a retinoscope/autorefractor)
- Subjective (using a phoropter)
- Cycloplegic (using cycloplegic drops)
-
Procedure
- Depends on the type of refraction used
- Typically, the individual is asked which of two images seems more clear.
- Normal findings: emmetropia (20/20 vision)
- Abnormal findings: reduced nearsighted vision, reduced farsighted vision
- Clinical significance: refractive errors (myopia, hyperopia, presbyopia, astigmatism)
Ishihara test![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: a color vision test in which a set of color-dotted plates is used to diagnose deuteranopia (green color blindness) and protanopia (red color blindness)
-
Indications [4]
- Color vision screening
- Age-related macular degeneration
- Drug toxicity (e.g., ethambutol, digoxin)
- Suspected congenital color blindness
- Suspected achromatism
-
Procedure
- The test consists of colored plates with numbers or shapes formed from dots of varying color and size.
- Adequate lighting is necessary to properly view the plates.
- The examiner shows the examinee the plates at random, generally starting with the number 12.
- The examinee is given three seconds to detect the number or shape.
- Normal findings: The examinee distinguishes all the colors, numbers, and/or shapes on the plates.
- Abnormal findings
- Failure to differentiate between colors, numbers, and/or shapes
- Additional diagnostic tests need to be performed (e.g., matching tests, retinal examination).
- Clinical significance: color blindness or dyschromatopsia (see “Color perception disorders” in “Diseases of the retina”)
Examination of extraocular muscles![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: An ophthalmologic examination that tests movement and alignment of the eyes (the examiner uses their finger or a specific target)
-
Indications
- Routine ophthalmological evaluation
- Thyroid disease
- Double vision
- Uncontrolled eye movements
-
Procedure
- Instruct the examinee to follow your finger while keeping their head immobile.
- While standing in front of the examinee, trace a letter "H" in the air: The eyes should move in six directions (upwards, downwards, right, left, and diagonally).
- Next, move the same finger towards the examinee's nose to test for accommodation: The eyes should converge while following the object to within 5–8 cm.
- Normal findings: The examinee is able to perform the six positions of gaze.
- Abnormal findings
- Lid lag, inability or limited ability to move the eye in a certain direction, continuous eye movements, eye misalignment
- Additional diagnostic tests need to be performed (e.g., cover tests, neurological examination).
-
Clinical significance
- Cranial nerve palsies: absent or reduced eye movement in a specific direction
-
Nystagmus or lid lag
- Caused by spasm of the superior tarsal muscle (smooth muscle portion of the levator palpebrae superiors) due to sympathetic overactivity
- The sclera can be seen above the iris as the examinee looks down.
- Strabismus
Cover tests![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: a type of ophthalmological examination used to detect the presence or degree of eye deviation.
- Procedure: The examinee's eye is covered for a few seconds, and refixation movements are observed after the eye is uncovered.
-
Indications: suspected eye misalignment
- Phoria: misalignment of the eyes when the patient views an object binocularly → disruption of binocular vision (heterophoria or latent deviation)
- Tropia: misalignment of the eyes when looking with both eyes uncovered (heterotropia or manifest strabismus)
- Types of cover tests
Overview of cover tests | ||
---|---|---|
Type | Procedure | Interpretation |
Single cover test for heterotropia | ||
Cover-uncover test for heterophoria |
| |
Alternating cover test |
|
- Clinical significance: strabismus (see “Ocular motility disorders and strabismus”)
Visual field examination![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: an ophthalmological examination used to assess light sensitivity and identify patterns of vision loss
-
Indications
- Routine ophthalmologic evaluation
- Metamorphopsias
- Suspected optic nerve damage
- Unexplained vision loss
- Elevated intraocular pressure
- Glaucoma
- History of orbital or retinal trauma
-
Types of visual field tests and their procedures [5]
-
Confrontation visual field exam: an ophthalmological examination used to evaluate for patterns of vision loss
- Stand facing the examinee (20–30 cm away), ask the examinee to cover one of their eyes, and then cover your own eye on the same side (e.g., if the examinee's right eye is covered, the examiner covers their left eye).
- Move your hand outwards beyond your own visual field (the area in which objects can be seen while focusing the eyes on a central point) until you can no longer see it, then move the hand inward while wiggling the fingers.
- Ask the patient to mention when they can see the examiner's fingers.
- This test should be performed for each visual field and then repeated on the other eye.
- Normal finding: The examinee detects the wiggling fingers at the same time as the examiner.
- Abnormal finding: Failure to detect the stimulus from a given direction indicates a visual field defect.
-
Automatic static perimetry: a systematic testing modality that uses a computer program; involves illuminating a static object to measure visual field function
- Position the examinee in front of the machine.
- One eye is tested at a time.
- Ask the examinee to fixate their eyes on a target and press a button when a light appears.
- This procedure is repeated several times using stimuli of different intensities but fixed sizes.
- The computer program will create different patterns (maps) of visual sensitivity that correspond to different diseases of the eye.
-
Kinetic perimetry: An ophthalmological examination used to diagnose visual field defects; moving light targets are used to identify the edge of the examinee's visual field.
- Position the individual in front of the machine.
- Ask the examinee to fixate their eyes on a target and press a button when an object enters their visual field.
- This process is repeated several times using a moving object of fixed size and intensity.
- The computer program will create different patterns (maps) of visual sensitivity that correspond to different diseases of the eye.
-
Amsler grid: a chart with dots or a combination of vertical, horizontal, and/or diagonal lines used to measure visual field function
- Position the examinee ∼ 30 cm away from the chart.
- One eye is tested at a time.
- Ask the examinee to fix their gaze on the central dot in the grid and describe the patterns they see.
- Ask the examinee if they can see the sides and corners of the grid and if any squares on the grid are blurry or missing.
- Record any abnormalities.
-
Confrontation visual field exam: an ophthalmological examination used to evaluate for patterns of vision loss
-
Clinical significance
- Optic nerve damage (see “Scotoma” in “Disorders of visual perception”)
- Glaucoma
- Hemianopsia
- Cataract
- Retinitis pigmentosa
- Macular degeneration
Pupillary examination![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Pupillary function test
-
Definition
- Part of the ophthalmological examination
- A penlight is used to assess pupillary size, location, shape, reactivity to light, and accommodation
- Indications
-
Procedure
- Room lights are dimmed or off.
- The examinee is positioned in front of the examiner.
- Ask the examinee to fixate their eyes on a point in the distance.
- Assess each eye for:
- Pupillary size and shape (normal size ∼ 3–5 mm, round-shaped)
- Direct pupillary light reflex
- Indirect pupillary light reflex
- Pupillary near reflex
- Clinical significance
Swinging flashlight test
- Definition: a physical examination technique used to identify afferent defects in the retina or optic nerve by comparing direct light reaction in both eyes
-
Indications
- Suspected afferent pupillary defect
- Unexplained vision loss
- Suspected neurological retinal lesions
-
Procedure
- Room lights are dimmed or off.
- The examinee is positioned in front of the examiner.
- Ask the examinee to fixate their eyes on a point in the distance.
- Swing a light back and forth from one eye to the other and compare pupil sizes.
- Normal findings: Each pupil contracts when illuminated and dilates when nonilluminated.
- Abnormal findings (positive swinging flashlight test): Both pupils appear dilated when the affected eye is illuminated.
-
Clinical significance
- Relative afferent pupillary defect (RAPD)/Marcus Gunn pupil: Both pupils constrict to a lesser degree when the affected eye is illuminated than when the unaffected eye is illuminated.
- Optic neuritis
- Retinal detachment
- Direct optic nerve damage (tumor, trauma)
For further information on pupillary abnormalities, see “Physiology and abnormalities of the pupil.”
Upper eyelid eversion![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: a procedure in which the upper eyelid is turned inside out to examine the upper palpebral conjunctiva
-
Indications
- Routine ophthalmological examination (typically performed immediately before slit lamp or external eye examination)
- Inspection of the palpebral conjunctiva and upper cul-de-sac
- Suspected foreign bodies under the upper eyelid
- Suspected floppy eyelid syndrome
- A bilateral eyelid malposition disorder characterized by eyelid laxity, eye pruritus, keratopathy, ptosis, and chronic noninfectious papillary conjunctivitis
- Commonly associated with obesity, sleep apnea, and keratoconus
-
Procedure
- Ask the examinee to look downwards for the duration of the examination.
- Pull the upper eyelid down with one hand.
- Apply pressure to the upper eyelid (∼ 3 mm above the root of the eyelashes) with a cotton swab or glass spatula.
- At the same time, pull the eyelid upwards and evert it over the cotton swab or glass spatula.
- Keep the upper eyelid in the everted position and remove the cotton swab or glass spatula.
- Inspect all parts of the conjunctiva, if possible; any foreign bodies should be removed.
- Release the upper eyelid and instruct the patient to look upwards
Slit lamp biomicroscopy examination![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
-
Definition
- An ophthalmological examination to evaluate for traumatic and nontraumatic disorders
- Conducted with a binocular microscope, which allows for a three-dimensional view of the eye
-
Indications
- Routine ophthalmological examination of the anterior eye segment or cornea
- Ocular foreign body
- Orbital trauma
- Lens dislocation
- Dry eye syndrome
-
Procedure
- Room lights are dimmed or off.
- Ensure that the correct configuration of the slit lamp microscope and that the examinee is correctly positioned in front of the examiner.
- Apply topical ophthalmic anesthesia.
- Ask the examinee to fix their gaze on a point in the distance.
- Evaluate the lower and upper eyelids, conjunctiva, and sclera.
- Evaluate the cornea (see also “Eye and orbit”).
- Corneal color and transparency
- Normal findings: clear, transparent
- Abnormal findings: foggy color, presence of deposits
-
Sensitivity: Assess using a cotton swab while the examinee is looking at a fixed point.
- Normal findings: blinking, lacrimation
- Abnormal findings: decreased sensation
- Corneal color and transparency
- Evaluate the lens
- Evaluate the iris
- Color: compare both eyes
- Normal findings: eyes are the same color
- Abnormal findings: eyes are different colors, presence of pigmented spots
- Pattern
- Normal findings: radial pattern
- Abnormal findings: muddy appearance, atrophy
- Color: compare both eyes
-
Additional tests
-
Fluorescein stain
- A type of staining used to identify corneal abrasions and foreign bodies in the eye
- Fluorescein (flourescent dye) stains the basement membrane, which is exposed following damage to the cornea.
- For more information on corneal abrasion evaluation, see “Corneal disorders.”
-
Seidel test
- A type of fluorescein is applied to the cornea during the slit lamp examination to assess leakage of aqueous humor from the anterior eye chamber.
- Indicated when there is suspicion of ocular leak due to orbital trauma
-
Tear break-up time
- A test of tear film stability
- During slit lamp examination, a fluorescein is applied to the tear film.
- The time until the tear film breaks up or shows patchy coverage is measured.
- Positive test: The tear film breaks up within 10 seconds.
- Indicated when there is suspicion of dry eye syndrome
-
Fluorescein stain
-
Clinical significance
- Corneal abrasion
- Keratoconjunctivitis sicca
- Herpetic infection
- Hyphema
- Red eye syndrome
- Lens dislocation
Gonioscopy![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: an ophthalmologic examination technique in which a special contact lens and a slit lamp microscope are used to illuminate and directly visualize the anterior chamber of the eye and iridocorneal angle
-
Indications
- Basal iridocorneal angle measurement
- Suspected angle-closure glaucoma (gold standard test) [6][7]
-
Procedure
- Ensure correct configuration of the slit lamp and correct positioning of the examinee in front of the examiner.
- Apply topical ophthalmic anesthesia.
- Room lights are dimmed or turned off.
- Ask the examinee to fix their gaze on a point in the distance.
- Place the special lens directly on the eye and visualize the iridocorneal angle directly using the slit lamp.
- Repeat the procedure on the other eye.
- Normal findings: normal width of the angle
- Abnormal findings: abnormal width of the angle, synechiae, neovascularization, hyperpigmentation
- Clinical significance: angle-closure glaucoma (see “Glaucoma”)
Tonometry![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: an ophthalmologic examination in which a tonometer is used to determine intraocular pressure (IOP) [8]
-
Indications
- Routine ophthalmological evaluation: determine baseline IOP
- Suspected glaucoma
- Ocular trauma
- Before and after eye surgery
-
Procedure
- Ensure correct configuration of the tonometer and correct positioning of the examinee.
- Apply topical ophthalmic anesthesia.
- Room lights are dimmed or turned off.
- Ask the examinee to fix their gaze on a point in the distance.
- Place the probe over the cornea.
- Measure the IOP.
- Normal findings: Standard values range between 10–21 mm Hg.
- Abnormal findings: values < 10 mm Hg or > 21 mm Hg
-
Clinical significance
- Primary open-angle glaucoma
- Retinal detachment
- Choroidal detachment
- Ruptured ocular globe
Fundoscopic exam![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: a component of the ophthalmologic examination in which an ophthalmoscope or fundoscope is used to visualize the retina, optic disc, choroid, and blood vessels
-
Indications
- Routine ophthalmological evaluation: visualization of the posterior retinal structures
- Retinal detachment
- Glaucoma
- Diagnosis of conditions related to chronic disorders (i.e., hypertension, diabetes mellitus)
-
Procedure
- Room lights are dimmed or off.
- Mydriatic eye drops may be used to make visualization easier.
- The ophthalmoscope's lens disc is switched to 0 diopters.
- The ophthalmoscope is positioned ∼15 inches away from the examinee and slightly lateral to their line of vision.
- Ask the examinee to fix their gaze at a point on the wall.
- When examining the right eye, the examiner should hold the ophthalmoscope in their right hand and look through their right eye (and vice versa).
- While keeping the ophthalmoscope fixed on the pupil, move the device towards the examinee's eye until almost touching the eyelids.
-
Components
-
Red reflex: an eye test that assesses the light reflection of the ocular fundus, which normally has a red color
- Normal findings: red colored reflection
-
Abnormal findings: absence of red reflex
- In children: may indicate congenital cataracts or retinoblastoma
- In adults: may be caused by cataracts or a detached retina
- Inspection of the external eye structures (eyelids, eyelashes, conjunctival abnormalities, pupillary abnormalities, and corneal abnormalities)
- Inspection of the anterior eye segment
- Assessment of the fundus
- Optic disc (contour, color, cup)
- Retina (Red reflex assessment), retinal vessels (clockwise assessment superior temporal, nasal, and inferior nasal and temporal)
- Macula and fovea
- Periphery of the fundus
-
Red reflex: an eye test that assesses the light reflection of the ocular fundus, which normally has a red color
Fundoscopic exam findings | ||
---|---|---|
Normal findings | Abnormal findings | |
Optic disc |
|
|
Retina and retinal vessels |
| |
Macula and fovea |
|
|
Periphery of the fundus |
|
|
Mydriatic drops are contraindicated in patients with narrow-angle glaucoma because they can induce an acute angle closure glaucoma.
Retinal examination![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Fluorescein angiography
- Definition: an imaging procedure in which fluorescein is injected intravenously to highlight retinal vessels, which are then photographed
-
Indications [9]
- Monitoring chronic disease progression (e.g., diabetes mellitus, hypertension)
- Changes of the fundus (e.g., due to inflammation, papilledema, vessel occlusion)
-
Procedure
- Fluorescein is injected intravenously into the arm or hand.
- The retinal blood flow is photographed
- Normal findings
- Bright retinal vessels on a dark background (pigment epithelium)
- Fluorescein dye remains intravascular.
- The fovea appears dark.
- Abnormal findings
- Hyperfluorescence: neovascularization , leakage of the retinal vessels (e.g., due to vascular inflammation)
- Hypofluorescence: vessel occlusion
- Clinical significance
Optical coherence tomography (OCT)
- Definition: a noninvasive imaging technique used to examine the retina, mainly for the diagnosis and monitoring of macular and optic disc anomalies
-
Indications
- Monitoring chronic disease progression (i.e., diabetes mellitus, hypertension)
- Suspected retinopathy due to inflammation
- Evaluation of the optic nerve
-
Procedure
- Ask the examinee to sit in front of the OCT machine.
- Adjust the head on the support and ask the examinee to remain still.
- Scan the eye (approx. 5–10 min).
- Normal findings: Layers and retina are the appropriate thickness.
- Abnormal findings: presence of fluid, holes within retinal layers, abnormal thickness of layers
-
Clinical significance
- Macular hole
- Age-related macular degeneration
- Optic disc pits
- Choroidal tumors
- Diabetic retinopathy
- Glaucoma
Electroretinogram
- Definition: a diagnostic test that uses electrodes to measure the electrical activity generated by the retina in response to light stimuli
-
Indications
- Monitoring chronic disease progression (i.e., diabetes mellitus, hypertension)
- Evaluation of retinal drug toxicity
- Retained intraocular foreign bodies
- Retinal disorders
-
Types
- Full-field electroretinogram (examination of the entire retina)
- Multifocal electroretinogram (examination of selections of the retina, especially the macula)
-
Procedure
- Ask the individual to sit in front of the electroretinogram machine.
- Apply topical anesthesia.
- Adjust the examinee's head on the support and ask the examinee to remain still.
- Place the electrodes in contact with the cornea or contact corneal lens.
- Present flashes to the individual (from lower to higher strength).
- Normal findings: normal response to stimulus in light adaptations, dark adaptations, oscillatory potentials, and flickering stimuli
- Abnormal findings: abnormal amplitude of response or time of response
-
Clinical significance
- Retinitis pigmentosa (see “Diseases of the retina”)
- Diabetic retinopathy
- Cone dystrophy
- Drug toxicity (e.g., chloroquine, hydroxychloroquine)
Electrooculography (EOG)
- Definition: an electrophysiological test that measures eye movement by detecting retinal voltage differences between two electrodes placed on the face (either superior and inferior to the eye or medial and lateral to the eye)
-
Indications
- Assessment of the retinal pigment epithelium
- Assessment of the vestibular system
- Abnormal eye movements
- Identification of REM sleep phases during polysomnography
-
Procedure
- Mydriatic eye drops may be used to make visualization easier.
- Attach the skin electrodes outside the eye near the lateral and medial canthus.
- Ask the examinee to remain still and move their eyes vertically and horizontally.
- The machine will record dark and light potentials (15 minutes each).
- Normal findings: normal Arden ratio (ratio between light and dark potentials), normal amplitude of potentials, normal pupillary size, consistent eye movements
- Abnormal findings: abnormal Arden ratio, no light adaptation, abnormal pupillary size, inconsistent eye movements
-
Clinical significance
- Nystagmus
- Macular degeneration
- Drug toxicity (e.g., chloroquine retinopathy)
- Choroidal melanoma
Schirmer test![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Definition: a test used to measure tear production [10]
-
Indications
- Basal tear secretion measurement
- Dry eyes
- Corneal ulcers
- Dacryostenosis
- Sjögren syndrome
-
Procedure
- Ask the examinee to look upwards.
- Pull the lower eyelid downwards.
- Place a sterile strip of filter paper at the lower eyelid margin.
- Repeat the procedure on the other eye.
- Ask the individual to gently close their eyes and keep the paper in place for 5 minutes.
- Remove the strips and measure the length of the wet area on each strip.
- Normal findings: length ≥ 10 mm
- Abnormal findings: length < 5 mm
-
Clinical significance
- Keratoconjunctivitis sicca
- Sjögren syndrome