Medically Fit For Exams
Medically Fit For Exams

Eye/visual examination

  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the examination and gain consent



  • Look at the eyes for evidence of:
    • Asymmetry/amblyopia (lazy eye)
    • Ptosis
    • Proptosis (protrusion)
    • Signs of systemic illness eg xanthelasma, corneal arcus etc
    • Redness



  • Ask the patient if the patient wears glasses/contacts, and ask them to put them on/in
  • Ask the patient to cover one eye and stand 6m (3m from half sized) from the Snellen chart
  • Ask the patient to read down the chart
  • If the patient is unable to see the chart:
    • Ask to count fingers
    • Ask to describe hand movements
    • Perception of light/darl


Visual fields

  • Sit in front of the patient, ask them to cover one eye, and cover your eye on the same side
  • Ask them to keep their head still and look straight at your face
  • Ask them to tell you when your finger comes into their line of vision
  • Position your arm halfway between yourself and the patient and bring your finger out from the periphery of the four quadrants. To test the same side as your covered eye, swap the hand that you are using to cover your eye
  • Ask the patient to swap eyes and repeat for the other eye
  • Test for visual neglect by asking the patient to point to the finger you are wiggling in the peripheries
  • Wiggle both sides independently and together
  • Compare the patient’s visual fields with your own, and compare between eyes


Pupillary reflexes

  • Shine the torch into one eye
  • The pupil should constrict in a direct response, the other pupil should also constrict in consensual response
  • Do the same for the other eye
  • Swing the light quickly back over to the first eye and back again to assess for a RAPD
  • The affected pupil will appear to dilate in response to light, as the consensual response from the opposite eye is intact, whereas the direct response is diminished


Eye movements

  • Sit in front of the patient, ask them to keep their head positioned facing towards you and only to move their eyes (you may have to steady their head if they can’t keep still)
  • Ask them to follow your finger with (both) eyes
  • Draw a large ‘H’ shape, holding at the peripheries to assess for nystagmus (flickering of eyes back to midline)
  • Ask if the patient has experienced any double vision



  • State that you would like to perform fundoscopy

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