Ophthalmic Exam

A comprehensive examination of the eyes and their functions is important for all individuals with ocular symptoms, and to screen for visual acuity, glaucoma, and retinal pathology. A routine examination includes testing for visual acuity, peripheral vision, and color vision, plus an examination of the external eye, conjunctiva, sclera, iris, pupil, and extraocular movements. Primary care clinicians evaluate and refer for visual acuity issues, and treat minor eye conditions such as infections, hordeola (styes), and corneal abrasions. Slit-lamp exams are performed by eye specialists or emergency providers to examine the cornea, anterior chamber, lens, and fundus. Dilated exams help examine the retina. Annual examinations are recommended for individuals with diabetes for early detection and treatment of retinopathy.

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Introduction

Overview

  • Vision testing:
    • Visual acuity
    • Peripheral vision
    • Color vision
  • Office exam:
    • Examination of the external eye
    • Conjunctiva
    • Sclera
    • Iris
    • Pupil
    • Extraocular movements
    • Ophthalmoscopic exam of the fundus
  • Detailed exam by slit lamp:
    • Cornea
    • Anterior chamber
    • Lens
    • Dilated exam of the retina

Eye examination recommendations

Recommended frequency of eye exams is not standard, but in general:

  • Children:
    • At birth
    • At 6–12 months
    • At 3 years of age
    • Early teens
    • Annually, if vision correction is needed
    • As needed for symptoms or injuries
  • Adults:
    • Once in the 20s and 30s
    • Every 2 years after 40–50 years of age including screening for glaucoma
    • Annually, if vision correction is needed
    • Annually for individuals with diabetes
    • As needed for symptoms or injuries

A dilated exam helps diagnose:

  • Diabetic retinopathy
  • Hypertensive retinopathy
  • Macular degeneration
  • Retinal detachment

History

  • Wellness exam or visual complaints
  • History of glasses or contact lens use
  • Family history:
    • Glaucoma
    • Color blindness
    • Other eye diseases
  • Chronic medical conditions
  • Surgical history
  • Medications

Anatomy

The eye and its appendages are situated in the orbit. The eyeball is spheroidal and attached to the extraocular muscles.

  • The front of the eye:
    • Cornea: the transparent anterior ⅙th of the outer eyeball
    • Sclera:
      • “White part” of the eye
      • Fibrous, protective, outer layer
      • Made up mainly of collagen and some crucial elastic fibers
    • Limbus: the junction of the cornea and sclera
    • Conjunctiva: the transparent mucus membrane that attaches to the limbus
    • Iris:
      • The “colored part” of the eye
      • Connected to the anterior part of the ciliary body
      • Covers the top of the lens and acts as a shutter for the eye
    • Ciliary body: holds the lens in place
  • Uvea (middle vascular coat of the eye):
    • Anterior uvea: iris and ciliary body
    • Choroid: Posterior portion of the uvea
      • Contains blood vessels that provide nutrients to the eye
      • Located between the retina and sclera
      • Extends to the optic nerve posteriorly
  • The back of the eye:
    • Retina:
      • The nerve coat of the eye
      • Responsible for the perception of vision
      • Contains several photoreceptor cells
      • Connected to the optic nerve
    • Macula (area in the center of the retina):
      • Responsible for clearly seeing objects in detail
      • Required for activities such as driving and reading
    • Fovea centralis: a small depression in the macula where vision is the sharpest
  • Extraocular muscles:
    • 6 muscles that control eye movements
    • 4 rectus muscles:
      • Superior
      • Inferior
      • Lateral
      • Medial
    • 2 oblique muscles:
      • Superior
      • Inferior
Eye anatomy

Anatomy of the human eye

Image by Lecturio.

Equipment for examination

  • Snellen chart or handheld pocket card for testing visual acuity
  • Ishihara chart for testing color blindness
  • Penlight for examining the pupils
  • Ophthalmoscope for examining the retina/fundus
  • Special equipment used primarily by eye specialists or emergency physicians:
    • Slit lamp to examine the cornea
    • Tonometer to measure intraocular pressure
    • Eye drops for pupillary dilation:
      • Phenylephrine
      • Atropine
      • Tropicamide
      • Cyclopentolate
    • Fluorescein and UV lamp to detect corneal abrasions
    • Amsler grid
    • Perimeter-testing machines

Vision Testing

Visual acuity testing

Snellen chart:

  • Shows a series of 11 lines of block letters on a white background, each progressively diminishing in size:
    • The smallest row that can be read accurately indicates the visual acuity in that specific eye.
    • Line 8 is 20/20 vision, indicating a person with normal visual acuity can read this line accurately from 20 feet away (6.1 m).
  • The “Tumbling E” eye chart can detect nearsightedness in young children or in individuals who cannot read.
  • Procedure:
    • The subject sits or stands 20 feet (6.1 m) from the Snellen chart.
    • The subject is asked to cover an eye, read the chart with each eye separately, and then with both eyes. Visual acuity for each is recorded as a fraction (e.g., 20/30).
    • Counting fingers test: tested if the subject is unable to read the top line even from 3 feet (0.91 m). The subject is asked to count the number of fingers held up by the examiner. Results are recorded as CF–1, 2, or 3 based on the number of fingers accurately visualized and counted. 
    • Hand movement: tested if the subject is unable to count fingers; recorded as HM positive or HM negative
    • Light-perception test: for subjects unable to count fingers or appreciate hand movements; recorded as PL positive or PL negative 

Near-vision chart:

  • Used to test near vision at a distance of 35 cm (14 inches)
  • Jaeger eye chart (with 10 lines of progressively smaller print) is commonly used:
    • Text sizes increasing from 0.37–2.5 mm
    • Acuity is recorded at the smallest line that can be accurately read by the subject.

Clinical relevance:

  • Refractive disorders can be treated with refractive devices (glasses or contact lenses):
    • Myopia: nearsightedness
    • Hyperopia: farsightedness
    • Astigmatism: Blurred vision due to a warped corneal surface causes light rays entering the eye along different planes to be focused unevenly.
  • Presbyopia:
    • Nonrefractive error in older adults
    • Affects visual acuity due to loss of normal lens accommodation

Visual field testing

The field of vision is the total area in which objects can be visualized while looking straight ahead; it includes central vision and peripheral vision.

  • Exam for peripheral vision = confrontation test
    • Procedure:
      • The examiner sits facing the subject at the same head level but at a distance of about 60 cm (2 feet).
      • The individual is asked to cover their left eye with the palm of their hand and is told to look straight into the examiner’s left eye.
      • The examiner closes their right eye and moves their hand in from the periphery toward the common line of vision.
      • The examiner announces that they can see hand movement when it enters their field of vision.
      • The movement of the hand is repeated in various parts of the field of vision, that is above, below, to the right, to the left.
      • The process is repeated for the other eye.
    • Results: The subject should confirm the movement of the hand in their field of vision, which is compared with that of the examiner (assuming it is normal).
  • Other tests used by eye specialists:
    • Perimetry:
      • Manual or automated perimeter machines are used to examine and quantify the visual field of individuals using targets of various sizes and colors.
      • Clinical relevance: Decreased peripheral vision may be due to damage to the optic nerve, retina, or areas of the brain that process vision (e.g., after a stroke).
    • Amsler grid:
      • A test for central vision loss occurring due to macular degeneration
      • Horizontal and vertical lines in a grid with a single dot in the center
      • 1 eye is tested at a time from 30 cm away.
      • The subject is asked to fix their vision on the central dot and describe any patterns they see in their vision.
      • Amsler grid is used to detect defects in the central 20 degrees of the visual field.
  • Clinical relevance
    • Testing of visual fields helps diagnose:
      • Optic nerve damage
      • Glaucoma
      • Hemianopsia
      • Cataracts
    • Amsler grid can be used to evaluate an individual’s central visual field, particularly for macular degeneration.
Testing visual fields

Testing visual fields:
The examiner’s left eye is closed, so he can compare the field of his right eye with the field of the subject’s left eye.

Image: “Testing visual fields” by Consultant ophthalmic surgeon, Department of Ophthalmology, Norfolk & Norwich University Hospital, and Honorary Reader, University of East Anglia, Norwich, UK. License: Cc BY 2.0

Color vision

  • Delineates red/green and total color perception deficiency
  • Can be performed in the office to diagnose color blindness
  • Ishihara color test: 14 colorful, numbered plates for mass screening and classroom use
Ishihara chart

Ishihara chart used for examining color vision

Image: “Ishihara chart” by Wellcome Trust. License: CC BY 4.0

Eye Examination

General exam of the face

  • Head posture:
    • May be abnormal in individuals with squinting
    • The head may be turned in the direction of action of the paralyzed muscle (e.g., stroke).
    • With ptosis, the chin is elevated to uncover the pupillary area.
  • Forehead:
    • Complete loss of wrinkling on 1 side of the forehead is seen in individuals with lower motor neuron facial palsy (e.g., Bell’s palsy).
    • Facial asymmetry may also be noted in individuals with sequelae of stroke, but only the lower half of the face is affected (not the forehead).
    • Mnemonic:
      • B as in Bell’s palsy: Both upper and lower face are affected.
      • S as in Stroke: Only the Smile is affected.

External eye

Preliminary examination for any gross anomalies in the eye and the surrounding structures is conducted in diffuse light. The clinically relevant findings are:

Eyebrow: 

  • Level of the eyebrows may be changed in individuals with ptosis.
  • Madarosis (absence of hair in the lateral ⅓rd of the eyebrows) is seen in:
    • Leprosy
    • Hypothyroidism

Eyelids:

  • Position:
    • Normally, the lower eyelid covers the nimbus and the upper eyelid covers 2 mm of the cornea with the eyes open.
    • In cases of ptosis, the eyelid covers more than ⅙th of the cornea.
    • Upper limbus may be seen due to lid retraction in:
      • Thyrotoxicosis
      • Sympathetic overactivity
  • Movement:
    • Normally, the upper lid follows the eyeball with downward movement.
    • With thyroid ophthalmopathy, the upper-lid movement lags behind the downward gaze.
    • Lagophthalmos (inability to close the eyes completely) seen with:
      • Facial nerve palsy
      • Extreme proptosis
    • Normal blinking rate is 12–16 per minute:
      • Increased with local irritation
      • Reduced with 7th nerve palsy
  • Lid margin:
    • Entropion: inward turning of the lid margin
    • Ectropion:
      • Outward turning of the lid margin
      • The common causes include trachoma, blepharitis, stye, and lid trauma.
    • Distichiasis: an abnormal extra row of eyelashes
    • Madarosis (absence of eyelashes) can be seen in:
      • Chronic blepharitis
      • Leprosy
      • Hypothyroidism
    • Swelling at lid margin may be due to:
      • Hordeolum (stye)
      • Papilloma
      • Marginal chalazion
    • Ankyloblepharon (horizontally narrow palpebral fissure) seen at angles of the eye after:
      • Adhesions of the lids after ulcerative blepharitis
      • Adhesions of the lids after burns
    • Blepharophimosis (narrow palpebral fissure): usually a congenital anomaly
    • Vertically narrow palpebral fissure seen in:
      • Inflammatory conditions of the conjunctiva
      • Inflammatory conditions of the cornea and uvea
      • Ptosis
      • Enophthalmos and anophthalmos
      • Atrophic bulbi
    • Vertically wide palpebral fissure seen in:
      • Proptosis
      • Retraction of the upper lid
      • Facial nerve palsy
  • Lacrimal apparatus:
    • Inspection of lacrimal sac area for:
      • Redness
      • Swelling
      • Fistula
    • Inspection of the lacrimal puncta for defects such as:
      • Eversion
      • Stenosis
      • Absence
      • Discharge
    • Regurgitation test for dacryocystitis: Press over the lacrimal sac area just medial to the medial canthus and observe for regurgitation of any discharge from the puncta.
Papillae on the everted upper eyelid in vernal keraconjunctivitis

Papillae on the everted upper eyelid in vernal keratoconjunctivitis

Image: “Papillae on the everted upper eyelid in vernal keraconjunctivitis” by Millicent Bore. License: CC BY 2.0

Conjunctiva

Examination:

  • Bulbar part of the conjunctiva can be examined by retracting the eyelid with the fingers.
  • Lower palpebral conjunctiva: Pull down the lower eyelid while the subject looks upward.
  • Upper palpebral conjunctiva: Retract the upper eyelid gently with the fingers.

Clinical relevance:

  • Discoloration:
    • Primary acquired melanosis: Unilateral, painless, brown macule can transform to malignant melanoma.
    • Pale conjunctiva: seen with anemia
    • Bright red patches: indicative of subconjunctival hemorrhage
  • Congestion:
    • Superficial: conjunctivitis
    • Deep: iridocyclitis or keratitis
    • Mixed: glaucoma
  • Edema:
    • Inflammatory conditions
    • Infection
    • Allergic reactions
  • Follicles:
    • Grayish-white raised areas (aggregation of lymphocytes) seen in:
      • Trachoma
      • Acute follicular conjunctivitis
  • Papillae (see photo):
    • Red, raised areas with flat tops
    • Seen in:
      • Trachoma
      • Allergic conjunctivitis
      • Giant papillary conjunctivitis (GPC)
  • Concretions:
    • Yellowish-white raised areas varying in size
    • Represent thickened mucous and dead epithelial cells in the glands of Henle
    • Seen in:
      • Trachoma
      • Conjunctival degeneration
      • Can be idiopathic
  • Pinguecula:
    • Yellowish, triangular, avascular nodule resembling a fat drop
    • Fatty/proteinaceous deposits on the conjunctiva (does not involve the cornea)
    • Develops on the bulbar conjunctiva in response to:
      • UV light exposure
      • Wind irritation
      • Dust irritation
    • May progress to pterygium
    • May or may not obscure field of vision
  • Pterygium (see photo):
    • Yellowish, triangular, vascular nodule resembling a fat drop
    • Fatty/proteinaceous deposits on the conjunctiva (involves the cornea)
    • Develops on the bulbar conjunctiva in response to:
      • UV light exposure
      • Wind irritation
      • Dust irritation
    • May be preceded by pinguecula
    • Generally affects the field of vision
  • Cysts: seen on the conjunctiva
  • Malignancies of the conjunctiva:
    • Dermoids
    • Papillomas
    • Squamous cell carcinoma
Pterygium

Severe pterygium reaching the pupil

Image: “Pterygium” by José Miguel Varas, MD. License: CC BY 3.0

Sclera

  • Examined at the same time as the conjunctiva
  • Clinical relevance:
    • Yellow sclera: jaundice due to liver disease
    • Bluish discoloration: osteitis deformans, Marfan’s syndrome
    • Inflammation: A pink or purple circumscribed flat nodule is seen with scleritis.
    • Episcleritis: deep, dusky patch associated with marked inflammation and ciliary congestion
    • Traumatic perforations can be seen in conditions of trauma.
    • Perforating trauma may communicate with the anterior chamber.

Iris

  • The “colored part” of the eye, examined in regular light
  • Anterior coloboma: a fissure or cleft of the iris:
    • Uveal coloboma lends a “keyhole” or “cat-eye” appearance to the iris:
      • May be benign
      • May be associated with serious lens and optic nerve defects
  • Synechiae: adhesions between the iris and other pupillary structures
    • Anterior synechiae are seen in:
      • Adherent leucoma
      • Leprosy
      • Perforating corneal injury
    • Posterior synechiae: seen with iridocyclitis
  • Congenital heterochromia iridis (different colored irides in the same individual) may warrant further evaluation for:
    • Waardenburg syndrome
    • Sturge-Weber syndrome
    • Horner’s syndrome
  • Iritis: leukocytes in the anterior chamber of the eye
  • Anterior uveitis: inflammation of the iris and anterior ciliary body
  • Iridocyclitis: inflammation of iris and adjacent ciliary body
    • Most common type of uveitis
    • May be limited to the eye or may signify systemic disease
    • Associated with rheumatological conditions:
      • HLA-B27-related ankylosing spondylitis
      • Psoriatic arthritis
      • Systemic lupus erythematosus
    • Associated with infectious diseases:
      • Herpes zoster
      • Cytomegalovirus
      • Toxoplasmosis
      • Syphilis
      • TB
    • Leukemia or lymphoma: may produce a leukocyte response that can be mistaken for inflammation

Pupil

  • Both eyes should have round, symmetric pupils.
  • Examine in dim light or in the dark with a flashlight to inspect:
    • Size
    • Shape
    • Color
    • Reactions
  • Size:
    • Normal: 3–4 mm
    • Unequal size of pupils: anisocoria
      • May be a benign physiologic condition that is longstanding (simple anisocoria)
      • May indicate an efferent pupillary defect seen in:
        • Cranial nerve III palsy
        • Pharmacologic mydriasis
        • Disorders of the iris
        • Horner syndrome/disturbance in the sympathetic pathway
    • Decreased size of the pupil (miosis) seen with:
      • Effect of local miotic drugs
      • Iridocyclitis
      • Horner’s syndrome
      • Head injury
      • Opioid use
    • Increased size of the pupil (mydriasis) seen with:
      • Effect of local mydriatic drugs
      • Acute congestive glaucoma
      • Optic atrophy
      • Retinal detachment
      • Cocaine and stimulant use
  • Shape (abnormal shape usually indicates prior surgery)
  • Color (depends on the structures located behind the pupil):
    • Jet black in aphakia
    • Grayish white in immature senile cortical cataract
    • Pearly white in mature cortical cataract
    • Leukocoria (white reflex in pupil (see photo)) seen in:
      • Congenital cataract
      • Retinoblastoma
      • Retrolental fibroplasia
    • Dirty white exudates are seen in iridocyclitis.
  • Pupillary exam for reactions:
    • Direct light reflex:
      • To elicit this reflex, the subject is seated in a dark room and a flashlight is used to elicit constriction. Repeat in the other eye.
      • A normal pupil reacts to light by constricting briskly.
    • Consensual light reflex:
      • A pupil is exposed to light and the response is noted in the other eye. The procedure is repeated for the other eye.
      • Normally, the contralateral pupil will constrict when bright light is directed at the ipsilateral pupil.
    • Swinging flashlight test:
      • To evaluate for an afferent pathway defect
      • Shine a flashlight on 1 pupil and note the constriction. The flashlight is then moved to the other eye and the pupil response is noted.
      • The to-and-fro swinging motion is repeated several times while observing the response of the pupils.
      • Normal response: Both pupils constrict equally. In an afferent pathway defect, the affected pupil will dilate when the flashlight is moved from the normal eye to the abnormal eye.
      • Known as Marcus Gunn pupil (relative afferent pupillary defect)
    • Near reflex:
      • The subject is asked to focus on a distant object and then instructed to suddenly focus on an object held at about 15 cm from their eye.
      • Normal response: Constriction of the pupil is observed when the subject tries to focus on the nearby object.
Child with retinoblastoma

Child with retinoblastoma of the right eye presenting with leukocoria

Image: “Pathology: Patient: Retinoblastoma” by National Cancer Institute. License: Public Domain

Cornea

The cornea is examined with a slit lamp or after corneal staining.

  • To examine for a corneal abrasion:
    • A drop of fluorescein dye is applied to the conjunctiva at the inside corner of the eye.
    • Corneal abrasions or ulcers stain bright green with fluorescein when viewed under UV light.
  • Clinical relevance
    • Size (abnormalities diagnosed in infants):
      • Microcornea: horizontal diameter < 10 mm
      • Megalocornea: horizontal diameter > 13 mm
    • Shape:
      • Normally, the cornea is a watch glass-like structure with a uniform posterior surface.
      • Keratometry and corneal topography tests are performed to analyze the curvature of the cornea.
      • Keratoconus: conical shaping of the cornea
      • Cornea plana: Flattening of the cornea may occur in individuals as a congenital anomaly.
      • Astigmatism:
        • Refractive condition
        • Warped corneal surface causes uneven focusing of light rays.
    • Sheen:
      • Normal cornea has a sheen.
      • Lost with “dry eye” conditions such as Sjögren syndrome
    • Sensation:
      • Blink reflex:
        • Examiner touches the corneal surface with a cotton wick.
        • Normal response is to blink.
        • May be impaired with neurologic conditions
      • Sensitivity of cornea is diminished in:
        • Herpetic keratitis
        • Neuroparalytic keratitis
        • Leprosy
        • Diabetes mellitus
        • End-stage glaucoma
        • After trigeminal block for postherpetic neuralgia
old keratic precipitates

Anterior uveitis: slit-lamp photograph showing large, old keratic precipitates

Image: “Anterior uveitis” by L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India. License: CC BY 2.0

Anterior chamber

  • Depth:
    • Measured using a slit lamp
    • Normal depth is 2.5 mm.
    • Shallow anterior chamber is seen with:
      • Primary narrow-angle glaucoma
      • Anterior subluxation of the lens
    • Deep anterior chamber is seen with:
      • Congenital aphakia (lack of lens)
      • Myopia
      • Keratoglobus
      • Keratoconus
  • Clinical relevance:
    • Hyphema (blood in the anterior chamber) seen in:
      • Ocular trauma
      • Ocular surgery
      • Iridocyclitis
    • Hypopyon (pus in the anterior chamber) seen in:
      • Corneal ulcer
      • Iridocyclitis
      • Endophthalmitis
    • Aqueous flare (inflammatory cells in the anterior chamber): seen as fine moving particles in cases of iridocyclitis
    • Foreign bodies may be found after traumatic injury (e.g., wood, iron, glass particles, stone particles, eyelashes).

Lens

Examination of the lens is done using a slit lamp after fully dilating the pupils.

  • Position:
    • Dislocation:
      • Anteriorly into the anterior chamber
      • Posteriorly into the vitreous chamber
    • Subluxation:
      • Partial displacement of the lens from its position
      • Observed as a shining golden crescent on focal illumination
      • Observed as a dark line on distant direct ophthalmoscopy
    • Clinical relevance: may have dislocation or subluxation with trauma
  • Transparency:
    • Opacity is indicative of a cataract.
    • Grayish or yellowish white
    • Clinical relevance of cataracts seen on ophthalmoscopy:
      • Congenital
      • Develop with aging and sun exposure
      • Side effect of corticosteroids
      • Diabetic cataract: “snowflake opacities”
      • Wilson disease: “sunflower cataract”
      • Concussion injury of the lens: “rosette-shaped cataracts”

Testing the intraocular pressure

  • Normal intraocular pressure: 10–21 mm Hg
  • Equipment used in screening for glaucoma:
    • Indentation tonometer (Schiotz tonometer)
    • Applanation tonometer (Goldman tonometer)
  • Clinical relevance
    • Ocular hypertension:
      • Increased intraocular pressure
      • No damage to optic structures and normal visual fields
      • Risk factor for glaucoma
    • Glaucoma:
      • Elevated intraocular pressure with optic nerve damage
      • Symptoms:
        • Blurred vision
        • Blindness
        • Pain in the eye
      • Requires immediate treatment to prevent vision loss
Tonometer

Tonometer used for measuring intraocular pressure

Image: “Tonometer” by University of California, Irvine School of Medicine, Emergency Department, Irvine, California. License: CC BY 4.0

Examination of the Fundus

Examination of the fundus is important to diagnose disorders of the vitreous humor, optic nerve, choroid, and retina.

  • Dilate the pupil with a mydriatic agent:
    • Phenylephrine
    • Atropine
    • Tropicamide
    • Cyclopentolate
  • Fundus can be examined using an ophthalmoscope:
    • Ocular media should be transparent.
    • Opacification can be seen with:
      • Corneal opacity (e.g., keratitis)
      • Lenticular opacity (e.g., cataract)
      • Vitreous opacities (e.g., hemorrhage)
  • Clinical relevance:
    • Examination of retinal blood vessels and abnormal findings:
      • Arterioles appear bright red and venules appear purplish.
      • Narrowing of arterioles may be seen in:
        • Hypertensive retinopathy
        • Arteriosclerosis
        • Central retinal artery occlusion
      • Tortuosity of veins may be seen in:
        • Diabetes mellitus
        • Central retinal vein occlusion
        • Blood dyscrasias
      • Drusen (yellow lipid deposits under the retina) seen in:
        • Normal with advancing age
        • Early sign of macular degeneration
    • Optic disc exam and abnormal findings:
      • Connection of the optic nerve to the retina
      • Pinkish white, 1.5-mm circular structure with a central “cup”
      • Hyperemia of the disc seen in:
        • Papilledema
        • Papillitis
      • Pallor of the disc: sign of optic atrophy
      • The normal cup to disc ratio is 0.3 and may be increased in glaucoma.
      • Neovascularization of the disc may occur in:
        • Diabetic retinopathy
        • Sickle cell retinopathy
    • Macular exam and abnormal findings (usually requires a slit-lamp exam):
      • Normal macula is slightly darker than the surrounding retina.
      • Center imparts a bright reflex (foveal reflex).
      • Macular hole: a round, full-thickness defect of retinal tissue in the foveal retina leading to the loss of central vision
      • Cherry-red spot seen in:
        • Central retinal artery occlusion
        • Tay-Sachs disease
        • Niemann-Pick disease
        • Gaucher’s disease
      • Macular edema seen in:
        • Trauma
        • Intraocular operations
        • Uveitis
        • Diabetic maculopathy
      • Hard exudates seen in:
        • Diabetic retinopathy
        • Hypertensive retinopathy
      • Pale macula: seen with macular degeneration in elderly individuals

References

  1. Khurana, A.K. (2018). Comprehensive Ophthalmology (4th edition, pp. 461-498).
  2. Sihota, R., Tandon. (2019). Parson’s Diseases of the Eye (22nd edition, Chapters 9-13, pp. 87-145).
  3. Jason, D. (2016). The 8-Point Eye Exam. American Academy of Ophthalmology. https://www.aao.org/young-ophthalmologists/yo-info/article/how-to-conduct-eight-point-ophthalmology-exam
  4. Ing, B.E. (2019). Neuro-Ophthalmic Examination. Medscape. Retrieved July 13, 2021, from https://emedicine.medscape.com/article/1820707
  5. Yadav, S., Tandon, R. (2019). Comprehensive eye examination: what does it mean? Community Eye Health, 32, S1-S4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC704181
  6.  Machiele, R., Motlagh, M., Pater, B.C. (2020). Intraocular Pressure. https://www.ncbi.nlm.nih.gov/books/NBK532237/
  7. Golnik, K.C. (2019). Congenital anomalies and acquired abnormalities of the optic nerve. UpToDate. Retrieved July 15, 2021, from https://www.uptodate.com/contents/congenital-anomalies-and-acquired-abnormalities-of-the-optic-nerve
  8. Rosenbaum, J.T. (2020). Uveitis: Etiology, clinical manifestations, and diagnosis. UpToDate. Retrieved July 15, 2021, from https://www.uptodate.com/contents/uveitis-etiology-clinical-manifestations-and-diagnosis

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