🧼 Wash your hands before starting.
Introduce yourself, confirm patient’s name & DOB.
Explain: “I’d like to check your eyesight, eye movements, and back of the eye with a light.”
Gain informed consent and ensure comfort.

🧰 Equipment Needed

Snellen chart 📊 (or equivalent, 6 m distance)
Pen torch 🔦
Ophthalmoscope 👁️
Near vision chart (optional, 33 cm)

👀 Step 1: General Inspection

Look for facial asymmetry, abnormal head posture.
Eyelids → ptosis, swelling, redness.
Conjunctiva → injection, discharge.
Sclera → jaundice, vascular congestion.
Cornea → scars, opacities.
Clinical pearl: Painful red eye with halos = acute glaucoma 🚨.

📊 Step 2: Visual Acuity

Snellen chart at 6 m (record as 6/6, 6/9, etc).
Test one eye at a time (occlude, not press).
If unable to read top line → move closer, then CF (count fingers), HM (hand movements), LP (light perception).
Repeat binocular vision if needed.
Pearl: Always do VA before using drops, lights, or ophthalmoscope.

🔦 Step 3: Pupils

Size, shape, symmetry.
Light reflexes: Direct + consensual.
Accommodation reflex: Constriction & convergence on near target.
Clinical pearl: RAPD (swinging light test) → optic nerve pathology (e.g. optic neuritis, severe glaucoma).

👁️ Step 4: Extraocular Movements

Ask patient to follow finger in an H-pattern.
Check all 6 directions of gaze.
Look for restriction, nystagmus, or diplopia.
Pearl: CN VI palsy = failure of abduction; patient turns head towards lesion.

🌐 Step 5: Visual Fields (Confrontation)

Sit 1 m opposite, cover opposite eyes.
Bring target in from periphery (4 quadrants).
Patient says “now” when seen → compare with your own field.
Pearl: Bitemporal hemianopia = pituitary macroadenoma; homonymous hemianopia = stroke.

🔍 Step 6: Ophthalmoscopy

Dim lights, ophthalmoscope at 0 diopters.
Approach from 15° temporal with same-side eye.
Look for:

Red reflex: absent in cataract/vitreous haemorrhage.
Optic disc: margins (blurred in papilloedema), colour (pale in atrophy), CDR (raised in glaucoma).
Vessels: AV nipping (HTN), microaneurysms (diabetes).
Macula: look last (bright light uncomfortable) → drusen in AMD.

🧪 Step 7: Extras (if time)

Near vision (33 cm card).
Colour vision (Ishihara plates).
IOP (tonometry, specialist).
Slit lamp (detailed anterior segment exam).

✅ Closure

Thank patient, ensure comfort.
Summarise findings: “Visual acuity 6/9 right eye, normal pupils, normal fields, fundus healthy.”
Wash hands 🧼.
Document accurately.

⭐ Key OSCE Tips

Systematic: Inspection → VA → Pupils → EOM → Fields → Fundoscopy.
Always test VA first.
Compare both eyes side by side.
Communicate clearly, reassure often.

🚫 Common Pitfalls

Forgetting VA at start (examiners often deduct marks).
Using incorrect Snellen distance.
Not comparing fields to own normal.
Poor positioning/lighting in fundoscopy.

📚 References

Kanski: Clinical Ophthalmology
OSCEstop – Eye exam station guides
The Ophthalmology Book (free resource)

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OSCE Eye Examination

👋 Introduction