Session 3. External Eye
• Good light.
• Fluorescein strips.
• Magnification of some
kind.(remember the ophthalmoscope
can be a magnifier).
• Va chart!!!!!
• Lids and position,lashes,shape,globe
• Inferior fornix
• Superior fornix
• Cornea and A.C.,limbus.
• Close apposition to the globe.
• Puncta not visible.
• Lower lid has a “square” edge.
• Lashes point forward.
• Lid closure covers the globe.
• Deposits ,scurf,redness,dilated vessels.
• Meibomian gland orifices.
LID Eversion Technique
• Pull the lid forward by holding the lashes.
• Place a swab stick or similar 10 mms from
the lid margin edge.
• Evert the lid by rotating the lashes over
• Pay particular attention to the tarsal
groove,a common place for FB’s.to lodge.
Grasp the lashes and pull forwar
to place the lid at a mechanical
Rotate and use
either a cotton
tipped applicator or
as a fulcrum.
Ophthalmoscope on + 1
• PUPIL response.
• Direct and consensual.
• Swinging light test.
• Muscle movements and types
• Cover test.
@23 degrees abduction @ 49degrees
Superior Superior Inferior
Rectus. Rectus Oblique.
Elevates. Inferior Extorts.
Adducts Oblique Abducts.
Inferior Inferior Superior
Rectus. Rectus. Oblique.
Extorts. Superior Depresses.
Adducts. Oblique Abducts.
3rd nerve 3rd nerve
Lateral rectus Medial rectus
• The cover test basically establishes
that both eyes are looking at the
• Cover and uncover.
• Cover and look behind.
• Rapid alternate cover.
• With children use an accommodative
target eg a toy that moves.
SIMPLE COVER TEST
• Technique.(red target and hands)
• Group work.
• Threshold machines and kinetic.
• Same level as patient.
• Cover other eye yourself!!!
• Compare left to right and right to left.
• You are comparing yourself to patient.
• Take age and awareness into account.
• Use a RED object.
• Finger or hand test for the confused.
• External Exam.
• Ophthalmoscope +1.
• Ocular mts.
• Cover test
• Confrontation fields
•This lesion has been present for
many years .
•The patient is worried if this
represents a potentially malignant
•How would you advice them?
•What is the scientific basis for the