Ocular assessment

Look

• Look at the orbit and surrounding structures for bruising, redness or injury.
• Look for injury to the eye (globe), including penetrating injuries, haemorrhage or hyphaema.
• Look for foreign bodies.
• Look at the conjunctiva. Compare the size and shape of the pupils. Look at the corneal clarity, the iris and the lens.
• Check the extraocular movement of both eyes.

Proptosis (bulging eye), loss of vision or orbital pain may indicate a retrobulbar haemorrhage. Escalate urgently as per local CERS protocol. If there is obvious trauma, examination may be brief.

Visual acuity

Assess visual acuity in all patients:

• Position the patient at the distance specified by the chart, usually 3 m or 6 m.
• Visual acuity is a ratio and is recorded in the form of x/y, where x is the testing distance, and y refers to the line containing the smallest letter that the patient identifies, e.g. a patient has a visual acuity of 6/9.
• If the patient wears glasses or contact lenses for distance, test with them.
• Test each eye separately.
• Check the patient is literate with the alphabet. If not, consider numbers, "illiterate Es" or pictures.