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Examination techniques

Examination techniques. Lecture 4 Mutez Gharaibeh,MD. Start with inspection. Be friendly Toys Avoid white coats Behave as a child , think as a man. History. Why they are here Birth history Developmental history General health Family history. Symptoms. Red spot in the eye.

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Examination techniques

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  1. Examination techniques Lecture 4 Mutez Gharaibeh,MD

  2. Start with inspection.

  3. Be friendly • Toys • Avoid white coats • Behave as a child , think as a man

  4. History • Why they are here • Birth history • Developmental history • General health • Family history

  5. Symptoms • Red spot in the eye

  6. Squint

  7. Epiphora

  8. Rubbing his eyes

  9. Uncomfortable in bright light (photophobia)

  10. Others • Sits close to TV • Not good with colors • Blinks a lot • Headache • Asthenopia • …. Etc

  11. Headache

  12. Diplopia • Monocular Vs Binocular • Muscle • Nerve • Neuromuscular • Orbit • Brain stem/Brain • Refractive

  13. Examination • Visual acuity • Inspection • Hirschburg test ( cornea light reflex) • Extraocular movements • Cover/ uncover test • Slit lamp test • Pupils • Fundi • Stereopsis

  14. Visual acuity<18 Mo • Response to occlusion • Hundreds and thousands ( > 6 mo)

  15. CSM • Central Steady Maintained • UCUSUM

  16. Visual acuity cards • Forced choice preferential looking

  17. The forced choice preferential looking • The forced choice preferential looking technique is very similar to the preferential looking technique, except that two or more stimuli are presented at the same time. • If the infant shows a preference for one stimulus over the other(s), the difference it and the others must be one that they can see. • For the researcher to know which differences the infant is responding to, the stimuli should differ on only one dimension. For example, if used to study developmental changes in contrast sensitivity, the stimuli should differ only in contrast and not other dimensions such as spatial frequency or luminance.

  18. Visual acuity cards • Keeler acuity cards • Teller acuity cards

  19. Teller cards • High contrast ,black-White square grating patch on a uniform grey cards. • Infants may appreciate the edge between the grating patch and the grey background ( overestimates visualacuity ). • This is overcome by the Keeler cards.

  20. Cardiff test • > 12 Mo.

  21. 18-36 Mo • Acuity cards . • Cardiff card. • Kay pictures

  22. Lea symbols

  23. Sheridan-Gardiner test • A,H,O,T,U,V

  24. 3-5 yr • Kay picture test • Sheridan –Gardiner test > 5 r • …… Snellen charts / LogMAR charts … etc

  25. Refraction • Retinoscopy

  26. Static retinoscopy • Distance fixation retinoscopy. • Cycloplegic refraction. • Retinoscopy under sedation ( sleep). • Near fixation retinoscopy( +/- Mohindra technique)

  27. Who should have cycloplegic refraction ? • Poor fixators • Any child with squint • When you suspect accommodatino spasm • Variable dry refractino results • When dry refraction --- manifest refraction donot match • Newly diagnosed / rapidly increasing myopia • Follow up of hypermetroipa

  28. Dilating drops

  29. Near fixation retinoscopy • Barret method • Dim light • Usually 67 cm working distance • A lens of equivalent diopteric power in front of each eye • Focus on featureless objects • Fog nonexamined eye

  30. PMT • Subjective refraction is rarely possible < 5 yr of age . • Guessing • Short attention span

  31. Continue your exam Next time

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