General appearance:

guide dog, walking cane, visual aids, glasses, eye patch.

Vital signs:

• Pulse – Irregularity (AF associated with transient episodes of visual loss)
• Blood Pressure – Hypertension
• Temperature- Cellulitis
• Consider BMI, BSL

Visual acuity:

• Best corrected visual acuity each eye separately followed by corrected vision with both eyes open, record your findings. You should understand how to record results.
• Testing with a standard Snellen’s chart requires the patient to be positioned at 6 metres from the chart. Smaller chats are now available commonly 3 metres. Always remember to check the chart and keep patients at the correct distance.
• If poor visual acuity always check for improvement with pin-hole (if it improves refractive error is likely).
• If not able to see any letters on chart:
  1. move closer to chart
  2. Count fingers held in front of each eye
  3. Hand movements
  4. Perception of light

Examination

Inspection: External eye (both eyes) with handheld light source

• Upper/lower eyelids: for erythema, oedema, lumps (chalazion, stye, skin tumours, zoster vesicles), lashes, lower lid position (ectropion or entropion).
• Exophthalmos (prominence of eyes), proptosis (protrusion of eyes from the orbits), seen best by looking at eyes from behind and above the patient