Operational Medicine Medical Education and Training

Eye Exam

Inspection of eyelids, conjunctiva and sclera:

  • Observe eyelids for redness, swelling, and lesion’s. 

  • Inflammation of an eyelash follicle with a lump, called a sty or hordeolum, is usually caused by staph. 

  • Check the position of the upper lid — it should cover the top part of the iris only but not the pupil. 

  • Ptosis is present when the upper eyelid droops over the pupil.

  • Check the conjunctiva and sclera for redness color or discharge. A yellow sclera indicates jaundice. 

  • Ask the patient to look up as you depress both lower lids with your thumb exposing the sclera and conjunctiva. 

  • A special exam is done if you suspect a foreign body — eversion of the upper eyelid. Ask the patient to look down, pull downward and forward on the eyelashes. Place a "Q" tip 1 cm above the lid margin and push down on the upper lid everting it. Alternatively, a bent paperclip can be used.

Pupils — Inspect the size and equality of pupils. Test the pupillary response to light — shine light obliquely into each eye. Look for:

  • Direct reaction (constriction of the same eye)

  • The consensual reaction (pupillary contraction in the opposite eye).

Extra ocular Eye Muscles:
Ask patient to watch your finger as you move it in six directions (think of a capital H) Watch for Nystagmus — the involuntary rhythmic rapid movement of the eye.

This video was produced by the Brookside Associates in 2008 to assist in orienting nursing students to this procedure.

The video may be freely downloaded.

Test visual acuity —Snellen chart at 20 feet is the best screening method.  

  • "Cover one eye and read the smallest line possible". 

  • Visual acuity is expressed as two number 20/30. 

  • The first number is the distance in feet from chart, the second the distance at which a normal eye can read the line of letters. 

  • Vision of 20/200 means that the patient can read print at 20 feet that a person with normal vision could read at 200 feet. 

  • You can test visual acuity with any available print.


Eye exam, looking up

Text from Operational Medicine 2001


Eye Exam Video
Runtime 0:43
2 MB wmv
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Eye Injuries Video
Runtime 19:45
14 MB wmv
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Eye Treatments Video
Runtime 8:42
6.3 MB wmv
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Chemical Burns of the Eyes Video
Runtime 0:33
9.5 MB avi
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