EXTERNAL INSPECTION Functional color blindness.

560,460,360,260,160 respectively or CF=counting finger 1m, CF 2m, CF 3m,CF 4m, CF 5m • If patient not able to count examiner finger close to face then examiner waves or moves his hand in about 25 cm from the patient eye and asks patient whether he is able to see hand movement or not. Visual acuity then recorded as HM+ or 1300. • When patient cannot distinguish hand movements, the examiner use penlight in front of the patient eye ± 20 – 25cm and notes whether the patient can perceive light or not. If he perceive light it is noted as LP light perception +ve otherwise as LP-ve. The examiner then reflect the penlight from four directions nasal, superior, temporal, inferior and asked the patient to mention the direction of the light. • Record accordingly if present patient perceive light from all directions it is marked as PR Projection of rays present or else mark as absent or defective. The test is repeated for the other eye in similar fashion Pin hole test Method • Place the pin hole occluder in front of the eye with reduced vision • Ask the patient to move their eye and head until some letters can be read on the letter chart • Ask the patient to read the lowest line of letters he can see looking through the pinhol Interpretation • If patient vision is improved with pin hole it means the poor acuity is due to refractive errors. eg. 612 PH 66 means visual acuity 612 can be improved with pinhole until 66 • If static acuity means may be due to structural or organic cause.eg.612 NI PH = non improved PH means the visual acuity still 612 with non improvement with pin hole • If reduced the poor visual acuity may be due to corneal opacity or lenticular opacity occupying papillary area or macular pathology. Charts for testing near vision are : 1 Snellen near vision chart 2 Jaeger chart 3 Roman test type Method of recording near vision • Ask the patient to sit with his back to the light • If the patient is using glasses for distance the same number will be put on the trial frame. Occlude one eye with an occulder • Ask the patient to hold the near vision by his right hand at a distance of 25 to 33 cms. • Note the near vision as per the letter read • Repeat the test for the other eye.

II. EXTERNAL INSPECTION

1. Eyelids Eyelids conditions  Diffuse swollen or edema, usually found in nephritic syndrome, heart disease, anemia, dacryoadenitis and hyperthyroid..  Eyelid swollen with sharp edge in chalazion, tumor.  Blepharospasm, happened on corneal erosin, anterior uveitis, acute glaucoma. Essential Blepharospasm did not result from organic disorders and usually happened billateraly. Blepharospasm could also be found at psychiatric patient with hysteria. Udayana University Faculty of Medicine, DME 50  Echymosis, the color of the eyelid changes as a result of blood extravatation after trauma.  Ectropion, is turning outward of the eyelids, could be found in elderly, paralise of the muscles, cikatriks and other.  Entropion, turning inward of the eyelids.In Trachomas patient the entropion usually happen in upper eyelids. Entropion could also happen due to parese of the muscles, cikatriks and senile condition.  Lagoftalmos: inabillity to close the eyelids completely.  Redness, inflamation, squama, tumour Merah, radang, keropeng skuama, tumor.  Pseudoptosis, difficulties to open the eyelids as if it is drooping. Happen on enophthalmos, phtisis bulbi, chalazion or the other eyelids tumour, eyelids edema and blepharochalazis.  Ptosis, drooping eyelids. Usually happen in elderly with history of intraocular surgery, Myasthenia gravis, Horner Syndrome, N III palsy, botulinum toxin injection  Cikatriks, scar on the eyelids  Trikiasis, silia atau bulu mata tumbuh salah arah sehingga dapat merusak kornea. Trikiasis dapat disebabkan blefaritis dan entropion.  Xantelasma, penimbunan deposit berwarna kekuning-kuningan pada kelopak, terutama nasal atas dan bawah. Xantelasma biasanya dihubungkan dengan hiperlipidemia dan dapat tanpa hiperlipidemia seperti pada histiosis dan retikulohistositoma. Abnormality of lower eyelids:  Similar with upper eyelids  Swollen of lacrimal sac, redness and sometimes pus came out when it be pushed.  Madarosis. Inerpalpebral Fissure  Normal  Narrow or small, if there is eyelids edema, blepharitis, ptosis, pseudoptosis, blepharophymosis  Wide or bigger, happened in hyperthyroid or intraocular tumour. Eyelids margin  Complete cilia  Trichiasis  Meibomian gland punctum secretion  Redness, pain and ulceration

2. Conjunctiva Upper Tarsal Conjunctiva