Makindo Medical Notes

Related Subjects: |OSCE Eye Exam |OSCE Ear Exam |OSCE Abdominal Exam |OSCE Ascites Exam |OSCE Jaundice Exam |OSCE Testicular Exam |OSCE Inguinal Exam |OSCE Upper limb Neurology |OSCE Lower limb Neurology |OSCE Face Neurology |OSCE Visual Fields

👋 Introduction

• 🧼 Hand Hygiene: Wash your hands thoroughly before starting.
• 🙂 Patient Introduction: Introduce yourself, confirm name and DOB, and explain the procedure.
• 📝 Consent & Explanation: Gain consent and explain you will test their side vision (peripheral vision).

🧰 Equipment Needed

• 📏 Snellen chart (mainly for central vision, if needed).
• ✏️ A pen, finger, or small target for confrontation testing.
• 💡 A well-lit room with plain background.
• 🎯 A fixation target (usually the examiner’s nose).

⚠️ Common OSCE errors:
– Not testing each eye separately (always occlude one eye 👁️).
– Homonymous hemianopia 👉 usually stroke affecting opposite hemisphere.
– Bitemporal hemianopia 👉 usually pituitary macroadenoma compressing the chiasm.

🪜 Step-by-Step Examination

• 👥 Preparation & Positioning:
  • Sit patient at eye level in good light.
  • Ask them to fixate on your nose (do not look at your fingers).
  • Explain: “Tell me as soon as you see my finger coming into view.”
• 👁️ Testing Each Eye (Confrontation):
  • Ask patient to cover one eye with hand/occluder.
  • You close your opposite eye (to mirror them).
  • Bring a finger/pen from periphery → centre in 4 quadrants.
  • Ask patient to say “now” when they first see it.
  • Note any areas missed → possible visual field defect.
• 🔄 Repeat on the Other Eye:
  • Switch occlusion and repeat exactly.
  • Compare fields between both eyes.
• 🧐 Additional Observations:
  • Check response consistency and reaction time.
  • If available, confirm with automated perimetry for precision.

🗒️ Documentation & Communication

• Record method used (confrontation test) and findings (e.g., “Right superior quadrantanopia”).
• Explain results sensitively to the patient.
• Recommend formal perimetry if defect detected.

⭐ Key OSCE Points

• Systematic: Preparation → Test Each Eye → Compare → Document.
• Clear communication keeps patient comfortable.
• Check fixation carefully → ensures accuracy.
• Always compare both eyes → asymmetry is key.

🚫 Common Pitfalls

• Not explaining → confused patient, poor cooperation.
• Poor fixation → unreliable results.
• Skipping quadrants → missed defects.
• Not comparing both eyes.

📚 References & Further Reading

• Geeky Medics: Visual Field OSCE Guide
• Clinical Methods – Walker et al.
• OSCEstop – Practice stations and notes.