are you sitting comfortably? then we shall begin. look over my shoulder
into the distance tell me what pictures you can see on the chart
do you see any other items in the background? just tell me what you are seeing in your distance
okay you've identified those there
moving on i have to come closer to inspect
the skin
starting with the areas
around the orbits
closer to the lashes
the nose bridge
okay moving up to the forehead
to the temples, down the side of the face
to the opposing side, quite clear, to the temple
let's back around the orbit please
and to this side down and lift your head
as clear as can be
try and look at the chart straight ahead
right
left
to the right
look at my light, now follow
superior temporal quadrant
midline
that's a good start so far
let's look at the orbits with white light
now look up
look down
to the side other side
blink, look up again
look to the right, look to the left
now up and down
that is the superior
we are inspecting the superior sclera
the iris the crypts and the collarettes
brown iris
iris freckles at three o'clock to the other six o'clock
look straight, i need more light to check hyperaemia
from each side from each side
temporally and nasally
the horizontal mid line
i need to introduce additional soft light but with a magnified view
five layers the cornea cross sectional viewing
meniscus
let's start on the tear meniscus
look right
left
up
down
are you experiencing any symptoms of dry eyes: lacrimation, hyperaemia, discharge?
watery
okay
all right into the mouth, open wide
first it's the tongue inspection
a very strong muscle probably the strongest muscle in the body, helps with your speech
taste receptors
raise the tongue
for more inferior vantage point as the inferior vantage point
vessels very prominent as well as the veins
open wide again to review the bonystructures
and back open wide
okay wisdom teeth superiorly protruding any uh tilted
no recent gum disease
discharge, pain on chewing?
onto the ears now please turn this way
some
tragus healthy
lobule
ear canal
discharge negative
wax about normal
ear drum
to the mastoid
just following the pathway there
nice clear magnified view there
just turn the other way now
okay what's going on on this side?
i'm quite happy with the canal, ,the helix the concha it's a little bit inflamed but
are you experiencing any pain?
any discharge?
like i just got into the mastoid process before the air comes
i can't see any discharge or scarring
tympanic membrane
a few deposits please avoid the cotton wood in your ears
some ear concerns there
any pain as i touch the ear?
all right we'll investigate that further late
we need to change the head
i'm going to say goodbye to the otoscope and helloto the ophthalmoscope
i'll
be coming very close looking at the oculus structures
start by looking straight looking for any signs of cortical, nuclear, posterior subcapsular cataract
established, at the corneas transparent, i'm going to change the focus, come closer
the vitreous body
so cranial nerve two is pink, defined
the margins
vascular clarity now, no signs of fly over vessels estimate the depth with the cupping medium,
i'll confirmed that on oct examination
looking into the light
central vision area
foveal light reflex
it's bright, there's no deposit there
let's just bring you this way a little bit please
okay let's you bring you just there please, just look straight
now from the nasal side we may have grade two cortical cataract, cortical cataract
nuclear sclerosis grade one to two, i shall confirm this
all right back to cranial nerve number two
as with the right plus no signs of splinter haemorrhages, medium depth cupping
all right, point four left, point five,
so now fly over vessels, peripapillary atrophy negative just a nice little scleral crescent
full 360. all right now look into the light
nice clear foveal reflex, there's no signs of oedema or elevations
there, negative macular haemorrhage negative
surrounding vascular ratio three to four, no signs of any nipping or tortuosity
all right
we need to finish off with eye pressure testing,
contact tonometry, let's see if we can locate the eye drops for you
okay one drop in each eye in the inferior fornix
look up to the ceiling
and again looking up
so
look dead straight
it's just brief contact on the epithelial surface
that
right 16 ml of mercury, for the left is 17 millimeters of mercury
i'll record all those results, i want to review everything again
in two years time, i'm going to let you go now