Ophthalmology Exam Procedures

Exam Logistics and Preparation

• Exam cycle duration at each station is 15 minutes, observational cycle is 3 min
• At the anterior segment and posterior segments skills stations, disinfect the slit lamp, focus it, and organize necessary equipment before patient interactions
• During patient encounters, connect the device to the docking station, take notes on the note board, and use hand sanitizer.

Anterior Segment Evaluation

• Proper disinfection of ocular instruments and hygiene must be maintained
• Best practice efficiency is to start temporally during slit lamp use

Biomicroscopy Procedure

• Assess the front health of the eyes using this process
• Instruct patients where to look throughout the procedure

Clinical Steps

• Use 10x magnification, low illumination, diffuse beam, 0 degrees to examine the eyelids and lashes
• Confirm upper and lower lids and lashes are clean
• Palpebral conjunctiva should be healthy and pink with lower lid eversion
• Check that inferior bulbar conjunctiva and sclera are white and quiet
• Verify that lower lid margin is clear and lower puncta are open with good apposition to the globe
• Verify that nasal and temporal bulbar conjunctiva and sclera are white and quiet
• Check that upper lid margin is clear and upper puncta are open with good apposition to the globe
• Confirm that superior palpebral conjunctiva is pink and healthy with upper lid eversion
• Use 16x mag, medium-high illumination with 3-4mm parallelpiped full height with variable angle technique
• Assessing superior and central cornea using parallelpiped and optic sections confirms that the epithelium, stroma, and endothelium are clear
• Use 16x mag, high illumination, 0.5mm optic section full height, 60-degree locked parameter to assess temporal anterior chamber angle
• Employ 16x mag, high illumination, conical beam (1mm x 1.5mm rectangle, 45 degrees to examine angle with room lights off
• Typically allow 15 seconds for dark adaptation to prevent cells or flares in the anterior chamber
• Utilize the parameters 16x mag, medium illumination, 3-4mm parallelpiped full height, 0 degrees to find iris conditions flat and avascular with a good pupillary response
• Employ 10x mag, medium illumination, 3-4mm parallelpiped, height equal to pupil size, 0 degrees to confirm that iris has no transillumination defects

Gonioscopy Information

• Assess the drainage system using procedure
• Instruct the patient of where to look throughout the procedure

Clinical Steps

• Use 16x mag, wide parallelpiped outside of the pupil, perpendicular to the flat mirror surface
• Inquire about allergies or pregnancy before instilling an anesthetic drop
• Add cushioning solution to the gonio lens
• Check for bubbles beneath the gonio lens or eyelashes trapped
• Identify inferior, superior, and nasal post visible structures as well as iris approach is

Goldmann Applanation Tonometry Information

• This procedure checks a patient's eye pressure
• Instruct the patient of where to look throughout the procedure

Clinical Steps

• With 10x mag, high illumination, diffuse beam, cobalt blue filter, and light housing on the temporal side, ask the patient
• Confirm allergies and pregnancy before instilling an anesthetic-fluorescein drop
• Make sure the cornea and tear film are clear before tonometry, use fixation target during the procedure
• Record results (mmHg) and time of reading.
• With normal readings (10-21 mmHg) recommend the patient have their eye pressure checked annually
• With high reading (>21 mmHg) tell the patient that pressure reading is higher than expected and recommend them return to clinic to have their eye pressure rechecked

Posterior Segment Evaluation

• Proper disinfection of ocular instruments and hygiene must be maintained

Binocular Indirect Ophthalmoscopy Info

• Procedure allows assessment of posterior health
• Instruct the patient of where to look throughout the procedure

Clinical Steps

• Get a clear image filling the condensing lens without the arcades in view and ask
• Ask preceptor if they have a view
• Posterior health with peripheral intact is a normal finding

Information About Dilated Fundus Exam

• Tool to assess lens, vitreous substance, and retina health after dilation
• Instruct the patient of where to look throughout the procedure when performing

Clinical Steps

• Anterior and posterior lens should be clear.
• Lens should have no defects w/ retroillumination (set to max)
• Anterior and posterior vitreous should be clear
• Optic nerve should have distinct margins and healthy rim tissue
• Normal C/D ratio is horizontal and vertical
• All arcades A/V ratio should be 2/3 without crossings
• Fovea should be flat and avascular with a +/- foveal reflex

Patient Encounter Station Details

• Essential information including patient demographics, chief complaints, current medications list, and symptom reviews
• Assessment data such as pretest info, refractive data, and anterior/posterior segment information
• Ancilary tests are not alterable in the system
• Evaluations to use to make written/verbalized assessments and plans