so today we're going to do a few
ocular measurements and checks. so as you can see i've got C.heap with me today from C.HeapASMR
so if you could start just by taking your glasses off for me now please. let's pop them on the table
okay i'm just going to ask you to look straight ahead
so i'm just going to have a little general look at the eyes just by lifting the lids
okay look down for me now
and i'm just going to have a little feel of the top lid looking for any lumps and bumps.
obviously we'd like to do this with a slit lamp
but this is just a gross look. looking up for me
if I did have any lumps on there, what would they be? we're looking for things like blocked
my meibomian glands or any styes or any tags, things such as milia, looking up for me,
and then you've got your more sinister things like rodent ulcers and carcinomas of the lids
that's fine so as you're looking straight ahead again just a little bit higher where
my fingers are keep looking there, just going to take a few measurements now with this ruler,
so i'm just checking the vertical palpable aperture there which measures at 11 mil,
that is the distance between the upper and the lower lid
and for the other eye we have about 10 mil there, excellent and as you're looking straight there
again i'm just going to, a little bit higher, that's it, i'm just going to measure the hvid,
the horizontal visible iris diameter and we have about 12 mil in the left
and 12 mil on the right, fairly equal which you'd expect, now as you're looking straight,
just there, keep looking there, we have this scale here, we're checking the pupil size,
obviously we're doing this in brighter conditions so the pupils will be
naturally smaller than if it were a dark room, so we certainly haven't got a 5 mil pupil in the left
so if we reduce it down to the smallest so Chris has about a 3.5 millimeter pupil size in the left,
looking in the right, we'll start at the 3, a bit small four maybe slightly large about 3.5,
so i've got an equal pupil size there, oh that's good, so this uh if there was a difference
it would be called an anisocoria, which could indicate a neurological problem,
the pupils are innovated, the muscles of, the muscles of the iris are innovated by the
third nerve, the oculomotor nerve, so with the further investigation if we saw or anything
and obviously another check we need to do for the pupils as chris is looking straight is check their
reaction to light, so if you shine the light in the right I'm just checking for a constriction
which we have there as you can see as we remove the light the pupil re-dilates,
we'll check a direct response in the left
and we have a response there i'm just checking the speed of constriction as well just to see
that they're matching, it happens at an equal speed, which seems fine, now for the consensual
responses, as Chris is looking straight i'll be looking at the left pupil for a constriction
as i shine the light in the right eye so just observe the left and as you can see
the left pure pull constricts even though we're not shining the light in that eye
we'll observe the left, oh sorry the right as we're showing the light in the left
and we're just looking for the constriction in this eye
and there it goes so Chris has a direct and consensual response in both eyes,
now as you continue looking straight we're going to do something called a swinging flashlight test
where we shine the light in the right give it about three seconds and then we check for the
constriction in the left three seconds straight to the other three seconds one two three and we're
just checking that there's no relative afferent pupillary defect which may show us the light
jumps to the the eye in as the light jumps you wouldn't see a constriction but more of a dilation
an RAPD could be associated with neurological problems
of the retina, so that works fine there, so as you're looking up again now we're just
going to observe the conjunctival surface, we're going to be using the Efron grading scale here,
the first section is dedicated to conjunctival redness and bulbar redness so we have three levels
moving to increasing severity of redness, the four is severe and zero is clustered as normal,
moving down we're going to have a look at Chris's bulba redness again starting from minor to severe
we're not going to focus on neovascularization because we probably need a slip lamp for this
and we're not going to focus on staining all the lid,s
so as chris is looking straight we'll do a conjunctival redness assessment
so we're going to use the magnifier to enhance our view and with the illumination, so just looking up
to the ceiling for me that's a lower the lid just observing the zones of the conjunctive looking to
the right hand side now and the left and just down to the ceiling down to the floor i mean,
okay so in the right side we're looking at at least a grade one which is the trace
and probably just a little bit less than a grade two so i'd grade that as 1.5
okay looking straight ahead again just observe the left and looking up
good and looking down
and to the right hand side now
and the left a little bit higher on the left and it's probably the same story there about a 1.5
conjunctival redness, so just looking up again, i'm just going to have a
little look at the limbal area using the ophthalmoscope
okay now looking down
and to the right and the left
okay now you might not be able to see perfectly but there is some slight yellowing on the white
part of the eye and this is known as pinguecula, which is just a little bit of fat growth
probably from uv light exposed to the eye over the years, just looking up for me
just have a look at the left limbus looking to the right and to the left and down to the floor
okay looking straight ahead there a little look at the cornea
okay
so looking at the limbal redness
we can certainly rule out grade three and four, a little bit more than a grade
zero so around the grade one to two area, just having a little closer look
Chris probably has again similar to the conjunctival redness a grade of 1.5
and that's it for today