Various symptoms can give cause for external inspection and examination of the anterior eye segment and/or the eye globe. In all cases the inspection is preceded by a vision examination to establish to what extent the eyesight of the patient is affected by the problem. The problems may originate in the conjunctiva, sclera, cornea, the anterior eye chamber or the lens of the eye.
Also in symptoms of these structures of the eye, the history-taking is based on the prediagnosis.
During the history-taking the following should be asked:
- How old is the patient?
- How long have the problems existed?
- Have the problems developed suddenly or gradually?
- Are both eyes equally affected?
- Do the problems occur when looking into the distance, close up, or both?
- Do the problems change depending on the nature of the light (more or fewer problems with bright light or dusk, respectively, with mist or low sunlight/at an angle of incidence?
- Has there been any trauma to the eye prior to the start op the problem?
- Does the patient have a systemic disease, a hereditary disease, or a chromosomal abnormality?
Procedures to prepare for the examination
Removing a contact lens
With hard contact lenses:
- First check if the contact lens is positioned loosely on the eye, i.e. not stuck.
- If this is the case, manipulate the lens with the eyelids in order to move it
(if necessary, flush generously with physiological saline solution) - Spread the eyelids using two fingers of one hand.
- Carefully place the eye plunger, in which you create a vacuum by pressing on it with thumb and index finger, straight onto the contact lens [Figure 53].
Figure 53
- Reduce the tension between your fingers to allow the eye plunger to ‘pick up’ the lens.
- You can now carefully remove the contact lens off the eye globe and place it in an allocated pot of contact lens fluid until you have completed the examination.
- Repeat this procedure for the other eye, if required.
There are also so-called DMV eye plungers available. These automatically attach to the lens when placed straight onto it.
With soft contact lenses:
- First check if the contact lens is positioned loosely on the eye, i.e. not stuck.
- If this is the case, manipulate the lens with the eyelids in order to move it
(if necessary, flush generously with physiological saline solution) Please note that with soft lenses movement may be very limited. You will, however, be able to determine if the lens is really stuck or if it moves slightly. - Ask the patient to look upwards, place your index finger onto the lens and move it down to the sclera.
- Make a pinching movement with your thumb and index finger and grasp the lens from the eye.
- Place the lens in an allocated pot, filled with fluid specific for soft contact lenses (physiological saline solution is acceptable as a temporary measure). Please note: soft contact lenses should always be stored in fluid.