Full eye exam routine
1. Learning objectives
By the end of this topic you should be able to:
● Decide which tests to include in an eye examination based on the patient’s case
history and presenting symptoms.
● Arrange these tests into a logical sequence, adapting the standard routine to the
patient’s needs.
● Understand roughly how long each stage should take within a typical 90-minute eye
exam (including prelims, refraction, ocular health).
2. Overview of a routine eye exam
A standard full eye exam typically includes three broad phases:
1. History and preliminaries
2. Refraction & binocular vision (BV) assessment
3. Ocular health assessment + additional tests & management
A typical routine sequence:
1. Case history
2. Visions / Visual acuity (VA)
3. Cover test (distance & near)
4. Ocular motility
5. Pupils
6. PD (pupillary distance) measurement
7. Refraction:
○ Trial frame / phoropter fitting
○ Retinoscopy
○ Subjective refraction (distance)
8. Distance BV tests
9. Amplitude of accommodation
10.Reading add & near BV tests
11.Near point of convergence (NPC)
12.Ocular health assessment:
○ Slit-lamp examination (anterior segment)
○ Direct / indirect ophthalmoscopy (posterior segment)
, 13.Further tests (as indicated):
○ Visual fields
○ Intraocular pressures (IOPs)
○ OCT
14.Management plan & clinical record
Timing:
● Preliminaries: should take about 5–10 minutes – you’re expected to be efficient.
● The whole eye exam is scheduled for about 90 minutes, including refraction and ocular
health.
3. Case history 5-10 mins
This is the foundation of the exam and guides which tests you prioritise.
3.1 General approach
● Start with an open question:
○ e.g. “How can I help you today?” or “Tell me about any problems you’ve been
having with your eyes.”
● Identify the chief complaint (CC).
● Use targeted follow-up questions to narrow down likely causes.
3.2 Symptoms to ask about
● Visual symptoms:
○ Blurred vision (distance / near / both)
○ Headaches
○ Diplopia (double vision)
○ Flashes and floaters
○ Eye strain, tired eyes
● Ocular symptoms:
○ Sore, watery, gritty, itchy, or red eyes
○ Photophobia (light sensitivity)
3.3 Current and previous correction
● Current spectacles/contact lenses:
○ Type of wear: distance / near / varifocal / contact lenses.
○ Vision with each pair at distance and near.
● Ocular history:
1. Learning objectives
By the end of this topic you should be able to:
● Decide which tests to include in an eye examination based on the patient’s case
history and presenting symptoms.
● Arrange these tests into a logical sequence, adapting the standard routine to the
patient’s needs.
● Understand roughly how long each stage should take within a typical 90-minute eye
exam (including prelims, refraction, ocular health).
2. Overview of a routine eye exam
A standard full eye exam typically includes three broad phases:
1. History and preliminaries
2. Refraction & binocular vision (BV) assessment
3. Ocular health assessment + additional tests & management
A typical routine sequence:
1. Case history
2. Visions / Visual acuity (VA)
3. Cover test (distance & near)
4. Ocular motility
5. Pupils
6. PD (pupillary distance) measurement
7. Refraction:
○ Trial frame / phoropter fitting
○ Retinoscopy
○ Subjective refraction (distance)
8. Distance BV tests
9. Amplitude of accommodation
10.Reading add & near BV tests
11.Near point of convergence (NPC)
12.Ocular health assessment:
○ Slit-lamp examination (anterior segment)
○ Direct / indirect ophthalmoscopy (posterior segment)
, 13.Further tests (as indicated):
○ Visual fields
○ Intraocular pressures (IOPs)
○ OCT
14.Management plan & clinical record
Timing:
● Preliminaries: should take about 5–10 minutes – you’re expected to be efficient.
● The whole eye exam is scheduled for about 90 minutes, including refraction and ocular
health.
3. Case history 5-10 mins
This is the foundation of the exam and guides which tests you prioritise.
3.1 General approach
● Start with an open question:
○ e.g. “How can I help you today?” or “Tell me about any problems you’ve been
having with your eyes.”
● Identify the chief complaint (CC).
● Use targeted follow-up questions to narrow down likely causes.
3.2 Symptoms to ask about
● Visual symptoms:
○ Blurred vision (distance / near / both)
○ Headaches
○ Diplopia (double vision)
○ Flashes and floaters
○ Eye strain, tired eyes
● Ocular symptoms:
○ Sore, watery, gritty, itchy, or red eyes
○ Photophobia (light sensitivity)
3.3 Current and previous correction
● Current spectacles/contact lenses:
○ Type of wear: distance / near / varifocal / contact lenses.
○ Vision with each pair at distance and near.
● Ocular history:
