OPENING SLIDE:
EXTERNAL EYE EXAMINATION and LID EVERSION
OPHTHALMOLOGY - D3 GROUP 2
(title slide before showing video) EXAMINATION OF THE OCULAR ADNEXA
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On gross inspection, inspect the eyebrows,
inspect the eyelashes, inspect the eyelids,
note for asymmetry and quantify the central
width of the palpebral fissure in millimeters.
Note for any abnormal motor function such
as impairment of upper lid elevation, forceful
lid closure, or incomplete lid closure.
Eyebrows
● Loss or extraordinary growth of hair
(e.g., alopecia areata, madarosis)
● Presence of seborrhea
Flash pictures & text after showing video
Eyelashes
● Matting or loss
Eyelids
● Presence of crusting, redness or
swelling (e.g. blepharitis)
● Note the position of the eyelids,
check for ptosis or lid retraction.
(title slide before showing video) EXAMINATION OF THE SCLERA, CONJUNCTIVA, CORNEA,
PUPIL, and IRIS
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Instruct the patient to look up, pull down the
lower lid of each eye to expose the inferior
sclera and conjunctiva.
Using a penlight, inspect the sclera and
conjunctiva of each eyeball for color,
vascularity, and swelling.
Inspect the cornea and note for any opacities
visible in the pupil.
Inspect the size, shape, markings, definition,
and color of the iris.
(title slide before showing video) EXAMINATION OF THE ORBIT AND PERIOCULAR SOFT
TISSUES
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Prior to palpation, inspect both orbits and
eyes for position, alignment, symmetry, size,
and shape.
In cases of suspected orbital trauma,
infections, or neoplasms, palpate the bony
orbital rim and periocular soft tissues.
Inspect and palpate for inflammatory signs
such as swelling, erythema, warmth, and
tenderness.
Auscultate for orbital bruit, as this may be a
sign of an underlying neurovascular
pathology.
(title slide before showing video) EXAMINATION OF THE GLOBE
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Standing behind the patient, look for
proptosis by instructing the patient to tilt
back the head. Examine the height of the
cornea in relation to the brow for asymmetry
between two eyes.
(title slide before showing video) OTHER DIAGNOSTICALLY RELEVANT EXAMINATIONS
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Lastly, depending on the circumstances,
checking for enlarged pre and post-auricular
(Sabay sabay pakita yung tatlong video in one lymph nodes, sinus tenderness, temporal
screen)
artery prominence, or skin and mucous
membrane abnormalities may be
diagnostically relevant.
(title slide before showing video) LID EVERSION
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For lid eversion, the patient is positioned and
instructed to look down.
Using the thumb and index finger of one
hand, gently grasp the upper lashes.
Using the other hand, position the applicator
handle just above the superior edge of the
tarsus.
The lid is everted by applying slight
downward pressure with the applicator, as
the lash margin is simultaneously lifted.
The patient continues to look down, and the
lashes are held pinned to the skin overlying
ENDING SLIDE
the superior orbital rim as the applicator is
withdrawn.
The tarsal conjunctiva is then examined.
To undo eversion, the lid margin is gently
stroked downward as the patient looks up.
References:
Riordan-Eva & Augsburger (2018). Vaughan &
Ashbury’s General Ophthalmology. 19th ed.
UST FMS Department of Medicine (2020).
MED1 Eye Examination Checklist.