ANATOMY OF

THE EYE
Roumel E. Litao, M.D.

A. Orbit
B. Eyeball
C. Extraocular muscles
D. Ocular adnexae
E. Optic nerve
ORBIT
Pear-shaped with the optic nerve
as its stem
Volume: 30 cc
20% of the space occupied by the
eye
7 BONES OF THE ORBIT
Frontal bone
Zygoma
Maxillary
Palatine
Lacrimal
Ethmoidal
Sphenoid

ORBITAL WALLS
1. Roof: frontal bone, sphenoid bone
2. Lateral Wall: sphenoid bone,
zygomatic bone
3. Floor: maxillary bone, zygomatic
bone
4. Medial Wall: ethmoid, lacrimal bone,
frontal bone, maxillary bone
- RELATIONSHIP TO SINUSES

Frontal sinus: above
Maxillary sinus: below
Ethmoid & sphenoid sinuses:
medial
ORBIT
ORBITAL APEX

Entry site of all the nerves & blood
vessels to the eye and all the
extraocular muscles except the
inferior oblique
ORBITAL APEX
BLOOD SUPPLY
A. Arterial Supply: ophthalmic artery (branch of
internal carotid artery)
1. Central retinal artery
2. Lacrimal artery: lacrimal gland & upper
eyelid
3. Muscular branches to the muscles
4. Long posterior ciliary arteries: ciliary
body
5. Short posterior ciliary arteries: choroid &
part of the optic nerve
6. Medial palpebral arteries: eyelids
BLOOD SUPPLY
B. Venous Drainage
Superior & Inferior ophthalmic veins
These veins communicate with the
cavernous sinus
The skin of the periorbital region drain to
the angular vein and to the superior
ophthalmic vein
So, there is a direct communication
between the skin of the face & the
cavernous sinus
EYEBALL
1. Conjunctiva: thin, transparent mucous
membrane
a) Palpebral conjunctiva: lines the
posterior surface of the eyelid &
adherent to the tarsus
b) Bulbar conjunctiva: covers the eyeball;
loosely adherent to the orbital septum in
the fornices & is folded many times
Semilunar fold: thickened fold at the inner
canthus & corresponds to the nictitating
membrane of lower animals
LAYERS OF THE
CONJUNCTIVA
1. Conjunctival epithelium
contains goblet cells
2. Conjunctival stroma
contains the accessory lacrimal
glands of Krause and Wolfring
TENONS CAPSULE
Fibrous membrane covering the
globe from the limbus to the optic
nerve
SCLERA
Fibrous outer layer of the eye
made up of collagen
Thinnest (0.3 mm) at the insertion
of recti muscles, elsewhere it is
0.6 mm thick
EPISCLERA
Thin layer of fine elastic tissue
which contains blood vessels that
nourish the sclera
EYEBALL
CORNEA
Transparent tissue inserted to the
sclera at the limbus
Thicker at the periphery (0.65
mm) than at the center (0.52 mm)
Horizontal diameter: 11.75 mm
Vertical diameter: 10.6 mm
5 LAYERS OF THE
CORNEA
1. Epithelium: 5-6 layers of cells
2. Bowmans membrane: clear acellular layer
3. Stroma: 90% of corneal thickness
Intertwining lamellae of collagen fibrils that
are parallel to each other
4. Descemets membrane: basal lamina of
corneal endothelium
5. Endothelium: single layer of cells which act
as a pump
CORNEA GETS ITS
NUTRITION FROM:
1. Limbal vessels
2. Aqueous
3. Tears
Sensory nerves come from CN
V1.
TRANSPARENCY OF THE
CORNEA
1. Uniform structure
2. Avascularity
3. Deturgescence
CORNEA
UVEAL TRACT
1. Iris
2. Ciliary body
3. Choroid
IRIS
Flat surface with central opening
pupil
Layers of the iris:
a) Stroma: contains the sphincter and
dilator muscles
b) Pigmented posterior layers
CILIARY BODY
Consists of 2 zones:
1. Pars plicata: 2 mm wide & from
which arise ciliary processes which
produce the aqueous
2. Pars plana: 4 mm flattened
posterior zone
MUSCLES OF THE CILIARY
BODY
1. Circular fibers: responsible for
accommodation
2. Longitudinal fibers: insert to the
trabecular meshwork altering the
pore size
3. Radial fibers
CHOROID
Posterior portion of uveal tract located
between the retina and sclera
Choriocapillaries: internal portion of
choroid which nourishes the outer
retina
UVEAL TRACT
LENS
Biconvex, avascular, clear
4 mm thick & 9 mm in diameter
Located behind the iris & connected to the ciliary
body by the zonules
Has a semi permeable lens capsule (to water &
electrolytes)
Consists of 65% water & 35% protein and minerals
Has subepithelial lamellar fibers continuously
produced making the lens larger & less elastic with
age.
AQUEOUS
Clear fluid that fills the anterior and posterior
chambers of the eye
Composition similar to plasma but with higher
amount of ascorbate, pyruvate; lactate, and lower
amount of protein, urea and glucose
Volume: 230 uL
Rate of production: 2.5 uL/min
ANTERIOR CHAMBER
ANGLE
Junction of the peripheral cornea & the root of the
iris
Main structures:
a) Schwalbes Line: corresponds to termination of the
corneal endothelium
b) Trabecular Meshwork: perforated sheets of collagen
& elastic tissue
c) Scleral Spur: inward extension of sclera in which the
ciliary body & iris are attached
ANTERIOR CHAMBER ANGLE
RETINA
Multi-layered sheet of neural tissue
0.1 mm thick at the ora serrata and 0.56 mm thick at the
posterior pole
Macula
Center of posterior retina
Seen clinically as 3 mm yellowish pigmentation to
xantophyll pigments
Fovea
Center of macula
Seen as depression and called foveal reflex
Foveola
Center of the fovea
Thinnest part of the retina
Photoreceptors are all cones

10 LAYERS OF THE
RETINA
1. Internal limiting membrane
2. Nerve fiber layer: ganglion cell axons going to optic nerve
3. Ganglion cell layer
4. Inner plexiform layer: connections of ganglion cells with the
amacrine and bipolar cells
5. Inner nuclear layer: cell bodies of amacrine, bipolar, and
horizontal cells
6. Outer plexiform layer: connections of these cells to the
photoreceptors
7. Outer nuclear layer: cell nuclei of photoreceptors
8. External limiting membrane
9. Photoreceptor layer: rods and cones inner and outer
segments
10. Retinal pigment epithelium

LAYERS OF RETINA
BLOOD SUPPLY OF THE RETINA
1. Choriocapillaries: supply the outer
third of retina from outer plexiform
layer to RPE
2. Central retinal artery: supplies the
inner 2/3 of the retina
VITREOUS
clear, avascular body
99% water, 1% collagen and
hyaluronic acid
2/3 of the volume and weight of the
eye
EXTRAOCULAR MUSCLES
1. Medial Rectus
- Adduction
- CN III
2. Lateral Rectus
- Abduction
- CN VI
3. Superior Rectus
- Elevation
- Intorsion, Adduction, CN
III
4. Interior Rectus
- Depression
- Extorsion, Adduction,
CN III

5. Superior Oblique
- Intorsion
- Depression, Abduction,
CN IV
6. Interior Oblique
- Extorsion
- Elevation, Abduction,
CN III

OCULAR ADNEXAE
Eyelids Layers
1. Skin
2. Orbicularis Oculi CN VII
3. Areolar tissue
4. Tarsal plates
5. Palpebral conjunctiva
LID RETRACTORS
Muscles that open the eyelids
A. Upper Lid
1. Levator palpebrae superioris
2. Mullers muscle
B. Lower Lid
1. Inferior rectus muscle
2. Inferior tarsal muscle

LACRIMAL COMPLEX
1. Lacrimal gland w/ orbital and palbebral portion
2. Accessory lacrimal glands of Krause and Wolfring
3. Canaliculi
4. Lacrimal sac
5. Nasolacrimal duct
LACRIMAL COMPLEX
OPTIC NERVE
1. Intraocular portion: optic nerve head; 1.5 mm in
diameter
2. Orbital portion: 25-30 mm long; 3 mm in
diameter
3. Intracanalicular portion: 4-9 mm long
4. Intracranial portion: 10 mm long
FIBERS OF THE OPTIC
NERVE
A. Visual fibers: 80%
B. Pupillary fibers: 20%
OPTIC NERVE
CRANIAL NERVES III, IV, AND VI

III - Oculomotor
IV - Trochlear
VI - Abducens

III (OCULOMOTOR) INNERVATES:

1) Medial rectus
2) Superior rectus
3) Inferior rectus
4) Inferior oblique

Levator palpebrae sup
Pupillary sphincter
Ciliary muscle

IV (TROCHLEAR) INNERVATES:

Superior oblique

VI (ABDUCENS) INNERVATES

Lateral rectus.

PROPRIOCEPTIVE INFO FROM EYE MUSCLES

comes through
Trigeminal nerve.

RISK FACTOR
AGE
Children and newborns suffer from eye diseases
very rarely and most of the patients exceed 40
years of age. Due to ageing of the trabecular
meshwork intraocular pressure rises even in
healthy people. In advanced age not only the
number of risk factors increases but also the loss of
nerve fibers occurs. The number of people with
higher eye pressure increases with age and
because the average life duration rises we should
not ignore this fact.

GENDER
In spite of the fact that women and men have usually the same
values of intraocular pressure, women are more affected by eye
diseases than men. One of possible explanations is that women
have more sensitive papillae of the optic nerve. Sex hormones
play an important role in regulation of intraocular pressure.
Intraocular pressure usually decreases during pregnancy and on
the other hand increases during menopause.


POOR NUTRITION (LOW VITAMIN A INTAKE)

Lack of Vitamin A causes degenerating night vision
which can, in serious cases, lead to total blindness.
It is most common amongst pregnant women and
preschool aged children in developing countries.
HEREDITY
People with a family history of eye
diseases have greater chance of
developing it.
EYE INJURIES
Injury to the eye may cause further eye
diseases. This can occur immediately after
the injury or years later.
Blunt injuries that bruise the eye (called
blunt trauma) or injuries that penetrate the
eye can damage the eyes drainage
system.
CIGARETTE SMOKING
Studies have shown that smokers and
former smokers at least double their risk of
developing eye diseases compared to non-
smokers.
ALCOHOL USE
Your overall visual performance may be altered since
drinking heavily impairs brain function. You may have
blurred vision or double vision due to weakened eye
muscle coordination. You may also experience
delayed reactions while driving.
Alcohol tends to affect the speed at which your iris
constricts and dilates. A driver that has been drinking
alcohol cannot adapt as quickly to oncoming
headlights.
Drinking alcohol has also been shown to decrease the
sensitivity of your peripheral vision. This may give you
the effect or perception of having tunnel vision.

POSSIBLE RISK FACTORS
High Blood Pressure
Abdominal Obesity
Use of Beta Blockers
HIGH BLOOD PRESSURE
Along with causing heart and kidney problems,
untreated high blood pressure can also affect your
eyesight and lead to eye disease. Hypertension can
cause damage to the blood vessels in the retina,
the area at the back of the eye where images focus.
This eye disease is known as hypertensive
retinopathy. The damage can be serious if
hypertension is not treated.
ABDOMINAL OBESITY
Abdominal fat releases estrogen and other
chemicals that may contribute to inflammation
associated eye diseases.
USE OF BETA BLOCKERS
Beta Blockers decreases intraocular
pressure
SCREENING TESTS
FOR EYES
OCULAR HISTORY

Taking an ocular history
What does the patient perceive to be the problem?
Is visual acuity diminished?
Does the patient experienced blurred, double, or distorted vision?
Is there pain; is it sharp or dull; is it worse when blinking?
Is the discomfort an itching sensation or more of a foreign body sensation?
Are both eyes affected?
Is there a history of discharge? If so, inquire about color, consiustency, odor.
What is the duration of the problem?
Is this a recurrence of a previous condition?
How has the patient self-treated?
What makes the symptoms improve or worsen?
Has the condition affected performance of activities of daily living?
Are there any systemic diseases? What medications are used in their treatament?
Whaht concurrent opthalmic conditions does the patient have?
Is there an opthalmic surgery history?
Have other family members had the same symptoms or condition?

EXTERNAL EYE EXAMINATION

Commonly, the upper 2 mm of the iris are covered by
the upper eyelid. The patient is examined for ptosis and
for lid retraction. Sometimes the upper eyelid turns out,
affecting the closure. The lid margins and lashes should
have no edema, erythema, or lesions. The examiner
looks for scaling or crusting, and the sclera is inspected.
The normal sclera is opaque and white. Lesions on the
conjunctiva, discharge, and tearing or blinking are
noted. The room should be be darkened so that the
pupils can be examined. The pupillary response is
checked with a penlight to determine if the pupils are
equally reactive and regular. A normal pupil is black. An
irregular pupil may result from trauma, previous surgery,
or a disease process.
The patient eyes are observed in primary or direct
gaze, and any head tilt is noted. A tilt may indicate
cranial nerve palsy. The patient is asked to stare at
a target; each eye is covered and uncovered
quickly while the examiner looks for any shift in
gaze. The examiner observes for nystagmus. The
extra ocular movements of the eyes are tested by
having the patients follow the examiners finger,
pencil or a hand light through the six cardinal
directions of gaze ( up, down,right,left,and both
diagonals). This is especially important when
screening patients for ocular trauma or for
neurologic disorders.

VISUAL ACUITY

Visual acuity (VA) is acuteness or clearness of vision,
which is dependent on the sharpness of the retinal focus
within the eye and the sensitivity of the interpretative
faculty of the brain.
[1]

Visual acuity is a measure of the spatial resolution of the
visual processing system. VA is tested by requiring the
person whose vision is being tested to identify
characters (like letters and numbers) on a chart from a
set distance. Chart characters are represented as black
symbols against a white background (for
maximumcontrast). The distance between the person's
eyes and the testing chart is set at a sufficient distance
to approximate infinity in the way the lens attempts to
focus. Twenty feet, or six metres, is essentially infinity
from an optical perspective.

DETERMINATION OF VISUAL ACUITY
Measure of visual acuity tests Cranial Nerve II, is a
measure of central vision
measures how well you see at various distances. It is the
familiar eye charttest.

1.Snellen chart- has number at the end of each line of letters
indicates
thedegree of visual acuity when measured at a distance of 20
feet. Thenumerator 20 is the distance in feet between
the chart and the client. Thedenominator 20 is the distance
from which the normal eye can read thelettering, which
correspond to the number at the end of each letter
line;therefore the larger the denominator the poorer the vision.

SNELLEN CHART
NOTE:
20/20 vision is a term used
to express normal visual
acuity (the clarity or
sharpness of vision)
measured at a distance of
20 feet.
If you have 20/20 vision,
you can see clearly at 20
feet what should normally
be seen at that distance.
If you have 20/100 vision, it
means that you must be as
close as 20 feet to see
what a person with normal
vision can see at 100 feet.
1 Secure the Snellen chart to a flat surface in a
well-lit room. The chart should be at a
comfortable height, which may change
depending on the individual's height.
2 Measure twenty feet from the chart and mark
a spot facing the chart directly. (The test results
will only be accurate if it is taken from this
distance.)
3 Stand at the twenty foot line and cover your
left eye, so you can only see out of your right
eye. Starting from the top, read each row from
left to right for as far down as you can still make
out the letters. Note the last line on which you
could correctly identify every letter. Have an
assistant verify that you are reading the letters
correctly.

4 Repeat the test with your left eye, covering your right
eye this time. Note the last row you could read with
complete accuracy. The row for each eye will not
necessarily be the same.
5 Take note of the fraction shown to the left of each
row: It identifies how your vision rates. For example, if
you could read to the fifth line, you have 20/40 vision; if
you could read to the seventh line, you have 20/25
vision.
6 Look at your results to determine the quality of your
eyesight. For example, someone with 20/60 vision can
read at 20 feet away what a person with normal vision
could read at 60 feet away. In the United States, a
score of 20/40 or better is required to drive a car
without corrective lenses, vision of 20/200 or worse
qualifies an individual as legally blind.


ISHIHARA PLATE
The test consists of a number of colored plates,
called Ishihara plates, each of which contains a
circle of dots appearing randomized in color and
size. Within the pattern are dots which form a
number or shape clearly visible to those with normal
color vision, and invisible, or difficult to see, to those
with a red-green color vision defect, or the other
way around. The full test consists of 38 plates, but
the existence of a deficiency is usually clear after a
few plates. There is also the smaller test consisting
only 24 plates.
Plates 1 17 each contain a number, plates
18 24 contain one or two wiggly lines. To
pass each test you must identify the correct
number, or The plates make up several
different test designs:
Transformation plates: individuals with color
vision defect should see a different figure from
individuals with normal color vision.
Vanishing plates: only individuals with normal
color vision could recognize the figure.
Hidden digit plates: only individuals with color
vision defect could recognize the figure.
Diagnostic plates: intended to determine the type
of color vision defect (protanopia or
deuteranopia) and the severity of it.
COVER-UNCOVER TEST
A cover test is an objective determination of the
presence and amount of ocular deviation. It is typically
performed by orthoptists, ophthalmologists and
optemetrists during eye examination.
The two primary types of cover tests are the alternating
cover test and the unilateral cover test (cover-uncover
test).
The test involves having the child (typically) focusing
on a near object. A cover is placed over an eye for a
short moment then removed while observing both eyes
for movement. The "lazy eye" will wander inwards or
outwards, as it begins to favour its perceptive visual
preference. The process is repeated on both eyes and
then with the child focusing on a distant object.

The cover test is used to determine both the type of ocular
deviation and measure the amount of deviation. The two
primary types of ocular deviations are the tropia, also
known as Strabismus, and the phoria. A tropia is a
constant misalignment of the visual axes of the two eyes,
i.e. they can't point the same direction. A phoria is a latent
deviation that only appears when fixation is broken and
the two eyes are no longer looking at the same object.

The unilateral cover test is performed by having the
patient focus on an object then covering the fixating eye
and observing the movement of the other eye. If the eye
was esotropic, covering the fixating eye will cause an
outwards deviation and vice versa. The alternating cover
test, or cross cover test is used to detect heterophoria,
where direct cover test will be normal for both eyes.

RELEVANT INFORMATION
TYPES OF BLINDNESS
Globally, it is estimated that there are 38 million persons
who are blind. Moreover, a further 110 million people have
low vision and are at great risk of becoming blind. The
main causes of blindness and low vision are cataract,
trachoma, glaucoma, onchocerciasis, and xerophthalmia
TYPES OF BLINDNESS: CATARACT,
TRACHOMA, GLAUCOMA
Cataracts, the world's leading cause of blindness, are an enormous public health
problem in both developing and industrialized countries.

Trachoma is still a widespread disease that causes
blindness in many developing countries, particularly
among rural populations.

Glaucoma is the second leading cause of vision loss in the world.
TYPES OF BLINDNESS:

ONCHOCERCIASIS
An estimated 17.7 million persons, most of them in Africa, are
infected with the parasite Onchocerca volvulus. Onchocerciasis
has caused blindness in 270,000 and left another 500,000 with
severe visual impairment. Onchocerciasis also can cause
disfiguring skin changes, musculoskeletal complaints, weight
loss, changes in immune function, epilepsy, and growth arrest.

XEROPHTHALMIA
Vitamin A deficiency remains a major cause of pediatric ocular
morbidity. Over five million children develop xerophthalmia
annually, a quarter million or more becoming blind.


ASSESSMENT OF THE EYES

EYE ASSESSMENT
Should be carried out in an orderly fashion

Moving from the extraocular to the intraocular structures

Usually includes testing of associated cranial nerves &
can be performed in the following order:
1.Determination of Visual Acuity
2.Assessment of external eye & lacrimal apparatus
3.Evaluation of extraocular muscle function
4.Assessment of anterior segment structures
5.Assessment of posterior segment structures

PLANNING
Place client in well lighted room

Nurse must be able to control natural and
overhead lighting during some portionsof the
examination

IMPLEMENTATION.
Explain procedure. Discuss how results will be used
in planning further care
Wash hands and apply gloves
Provide privacy
Inquire history

ASSESSMENT OF EXTERNAL EYE AND LACRIMAL
APPARATUS
External examination of eyes consists of:
1.inspection of the eyelids, surrounding tissues and
palpebral fissure.
2.Palpation of the orbital rim may also
be desirable, depending on the presenting signs
and symptoms.
3.The conjunctiva and sclera can be inspected
by having the individual look up, and shining a light
while retracting the upper or lower eyelid.
4.The cornea and iris may be similarly inspected

ASSESSMENT OF EXTERNAL EYE AND LACRIMAL
APPARATUS
1. Inspect the eyelids for position and symmetry.

2. Palpate the eyelids for the lacrimal glands.
-a. To examine the lacrimal gland, the examiner,
lightly slide the pad of the index finger against the clients upper
orbital rim.
-b. Inquire for any pain or tenderness.
3. Palpate for the nasolacrimal duct to check for obstruction.
a. To assess the nasolacrimal duct, the examiner presses
with the index finger against the clients lower inner orbital
rim, at the lacrimal sac, NOT AGAINST THE NOSE.
b. In the presence of blockage, this will cause regurgitation
of fluid in the puncta
Normal Findings: Eyelids
Upper eyelids cover the small portion of the iris, cornea, and
sclera when eyes are open.
No PTOSIS noted. (drooping of upper eyelids).
Meets completely when eyes are closed. Symmetrical.

Lacrimal Apparatus
Lacrimal gland is normally non palpable.
No tenderness on palpation.
No regurgitation from the nasolacrimal duct

EVALUATION OF EXTRAOCULAR
FUNCTION
This test is an examination of the function of the eye muscles.
A doctor observes the movement of the eyes in six specific
directions.
Client are asked to sit or stand with your head erect and a
forward gaze. Nurse will hold a pen or other object 12 inches
in front of your face. Nurse will then move the object in several
directions and ask client to follow it their eyes, without moving
their head.
Normal Results
-Normal movement of the eyes in all directions.

What Abnormal Results Mean
-Eye movement disorders may be due to abnormalities of the
muscles themselves or problems in the sections of the brain
that control these muscles.
ASSESSMENT OF THE ANTERIOR
STRUCTURES
The anterior segment is the front third of the eye that includes
the structures in front of the vitreous humor: the cornea, iris,
ciliary body, and lens

ASSESSMENT OF EYE STRUCTURE
Implementation
1.Explain procedure. Discuss how results will be used in
planning further care
2.Wash hands and apply gloves
3.Provide privacy
4.Inquire history

Eyebrows (hair and skin quality)
Normal findings:
Hair evenly distributed, skin intact
Symmetrical eyebrows w/ equal movements

Deviations from Normal:
Loss of hair, scaling/flakiness of skin
Unequal alignment / movement of eyebrows

Eyelashes
Normal Findings:
Equally distributed, curled slightly outward
Deviations:
Lashes turned inward

Eyelids
Normal Findings:
Skin intact, no discharge, no discoloration
Lids close symmetrically
Approx. 15-20 involuntary blinks/minute, bilateral blinking
When lids open, no visible sclera above corneas. Upper/lower
borders of cornea are slightly covered

Deviations:
Redness, swelling, flaking, crusting, discharge
nodules/lesions
Lids close asymmetrically, incompletely or painfully
Infrequent blinking
Ptosis, ectropion lower lids rolled out) or entropion (lower lids
rolled in), rimof sclera visible between lid and iris

Bulbar conjunctiva-retract eyelids,
-exert pressure over upper & lower bony orbits and ask client to
look up & down & sideways
Normal Findings:
Transparent, sclera appears white (yellowish in dark skinned)

Deviations from Normal:
Jaundiced sclera (liver dis), excessively pale sclera, lesions/n
odules(mechanical, chemical, allergic or bacterial damage)

Palpebral Conjunctiva
- Evert & retract both lower lids & ask client to look up.
Normal Findings:
Shiny, smooth and pink/red
Deviations from Normal:
Extremely pale (anemia), red (inflammation), nodules or
lesions

Lacrimal Gland
-inspect and palpate
Normal Findings:
No swelling /tenderness over lacrimal gland
Deviations from Normal:
swelling /tenderness over lacrimal gland

Lacrimal sac and nasolacrimal duct
- inspect & palpate
Normal Findings:
No edema & tearing
Deviations from Normal:
Increased tearing, regurgitation of fluid on palpation of
lacrimal sac

Cornea
1. Inspection: Ask client to look straight, hold penlight at
oblique angle of eye &move light slowly across corneal
surface.
Normal Findings:
Shiny, smooth. Details of iris are visible
Arcus senilis (grayish w/ white ring around margin in older
persons

DIAGNOSTIC/ LABORATORY
EXAMINATIONS FOR
DISTURBANCES IN VISUAL
PERCEPTION


OPHTHALMOSCOPY

(funduscopy or fundoscopy) is a test that allows a
health professional to see inside the fundus of the
eye and other structures using
anophthalmoscope (or funduscope).
It is done as part of an eye
examination and may be done as part
of a routine physical examination. It
is crucial in determining the health of
the retina and the vitreous humor.

It is of two major types:
Direct Ophthalmoscopy one that produces an upright,
or unreversed, image of approximately 15 times
magnification.
Indirect Ophthalmoscopy one that produces an
inverted, or reversed, direct image of 2 to 5 times
magnification.
Disturance(s)
Cataract
Glaucoma
Retinal Detachment

The Slit Lamp
is an instrument consisting of a high-
intensity lightsource that can be focused to shine a
thin sheet of
light into the eye.
It is used in conjunction with a biomicroscope.
The lamp facilitates an examination of the
anterior segment,
or frontal structure
s and posterior segment, of the human eye,
which includes the eyelid, sclera, conjunctiva,
iris, natural crystalline lens, and cornea.
The binocular slit-lamp examination provides a
stereoscopic magnified view of the eye structures I
detail, enabling anatomical diagnoses to be made
for a variety of eye conditions. A second, hand-held
lens is used to examine the retina.
Disturance(s)
Retinal Detachment
Cataract
Color Fundus Photography

Is used to detect and document retinal lesions. The
patients pupil are widely dilated before the procedure.

Ultrasonography
In ultrasonography, or ultrasound, high-frequency
sound waves, inaudible to the human ear, are
transmitted through body tissues. The echoes are
recorded and transformed into video or photographic
images.

Optical Coherence Tomography
(OCT) is an optical signal acquisition and processing
method.
It captures micrometer-resolution, three-dimensional
images from within optical scattering media (e.g.,
biological tissue). Optical coherence tomography is
an interferometric technique, typically
employing near-infrared light.
. The use of relatively long wavelength light allows it
to penetrate into the scattering medium. Confocal
microscopy, another similar technique, typically
penetrates less deeply into the sample.

Disturance(s)
Retinopathy
Tonometry
is the procedure eye care professionals perform to
determine the intraocular pressure (IOP), the
fluid pressure inside the eye. It is an important test in
the evaluation of patients at risk from glaucoma.
Most tonometers are calibrated to measure pressure
in millimeters of mercury (mmHg).


Disturance(s)
Cataract
Glaucoma
Indocyanine Green Angiography
a diagnostic test that involves taking photographs of
the blood vessels in the eye with the help of a
contrast dye. Indocyanine is a green dye that works
with infrared light and is visualized with a special
camera. The images produced by this test help
doctors evaluate the retina and diagnose or monitor
problems such as macular degeneration, abnormal
vessel growth, macular edema, certain
Perimetry Test
(Visual Field Testing) for Glaucoma
A perimetry test (visual field test) measures all areas
of your eyesight, including your side, or peripheral,
vision
Disturance(s)
Glaucoma
Fundus Photography
(also called fundography
[1]
) is the creation of
a photograph of the interior surface of the eye,
including the retina, optic disc, macula, andposterior
pole (i.e. the fundus

Disturance(s)
Retinal Detachment
Ophthalmic Radiography
Its using radiation to generate a picture of the eye.
Similar to what an MRI is, but on the eye instead of the
head/brain. Canon appears to be the major manufacturer
ofOphthalmic Radiography equipment.

MRI scan

MRI (magnetic resonance imaging) is a fairly new
technique that has been used since the beginning of
the 1980s.
The MRI scaner uses magnetic and radio waves to
create pictures of tissues, organs and other
structures within the body, which can then be viewed
on a computer
Electroretinography
measures the electrical responses of various cell
types in the retina, including
the photoreceptors (rods and cones), inner retinal
cells (bipolar and amacrine cells), and the ganglion
cells



OPHTHALMODYNAMOMETRY
DETERMINATION OF THE BLOOD PRESSURE IN THE
RETINAL ARTERY.

Intravenous Fluorescein angiography (IVFA) or fluore
scent angiography is a technique for examining the
circulation of the retina and choroid using a
fluorescent dye and a specialized camera. It involves
injection of sodium fluorescein
[1]
into the systemic
circulation, and then an angiogram is obtained by
photographing the fluorescence emitted after
illumination of the retina with blue light at
a wavelength of 490 nanometers. The test uses
the dye tracing method.

Disturance(s)
Retinal Detachment
Retinopathy
Electronystagmography
(ENG) is a diagnostic test to record involuntary
movements of the eye caused by a condition known
as nystagmus. It can also be used to diagnose the
cause of vertigo, dizziness or balance dysfunction by
testing the vestibular system.