(1) Note the general appearance of the eyelids, eyelashes, and lacrimal
apparatus. Observe for:
(a) Redness around the eye.
(b) Discharge or crusting.
Growths on eyes or eyelids.
(d) Excessive tearing.
(2) Position and mobility can be observed by having the patient rotate the
eyes, looking up, down, and to each side.
b. Pupillary Response. Normal pupils are rounded, centrally placed, and
generally equal in size. (About 25 percent of normal individuals have pupils slightly
unequal in size.)
(1) Reaction to light. Seat the patient in an area with even lighting and
instruct him to fix his gaze on a distant object. Cover one eye and shine a flashlight in
front of the exposed eye. The pupil should contract (constrict) because of the light.
This response is called a direct reaction. The covered pupil should also contract. This
response is called a consensual reaction.
(2) Near point reaction. When the gaze is changed from a distant object to
an object close at hand, the pupils should contract.
c. Ophthalmoscopic Examination. By looking through the various lenses of
an ophthalmoscope, the trained examiner can view and assess the internal structures of
the eye. This examination is routinely performed by the physician.
d. Functional Examinations.
(1) Focusing power (power of accommodation) is tested by placing a line of
print close to the eye, then slowly moving it back to the point at which the patient is able
to read it. The nearest point at which it is readable is the near point of accommodation.
(2) Visual field refers to all that can be seen with both eyes fixed straight
ahead. To perform a gross examination of visual field, the confrontation method is used
(figure. 1-3). Have the patient and the examiner face each other at a distance of about
2-3 feet, each focusing his gaze at the other's nose. The examiner should then extend
his arm to the side, point his finger, and slowly move his arm back in, along a plane
half-way between himself and the patient. The examiner's finger should appear in the
patient's visual field at the same time the examiner sees it (assuming the examiner's
visual field is grossly normal).