Remote Examination of The Eyes
Rodolfo T. Rafael,MD

    From a distance, note the increased or diminished width of the palpebral fissures, whether unilateral or bilateral. Note protrusion or recession of one or both globes by inspecting the eyes from the front; if in doubt, look at the profile; finally, look downward over the patient's forehead and the superior edges of the orbits.
    Test for lid lag, holding your finger or a penlight as a target in the midline above eye level, about 20 inches (50 cm) away move the target rapidly downward in the midline, watching for the appearance of white sclera between the iris and the upper lid margin. Test the extraocular movements by moving the targets at eye level from one side to the other, noting failure of the eyes to follow; similarly, test by moving the target from upper right to lower left, and upper left to lower right. Finally, test convergence by holding the target in the midline and at eye level, about 20 inches (50 cm) from the face, gradually moving the target toward the bridge ofthe patient's nose; note the near point at which convergence fails (normally 2 to 3 inches, or 50 to 75 mm)
    Test for gross defects in the visual fields by the confrontation method. Have the patient cover his left eye with his hand. Place your face in front of the patient's at the same eye level, with your nose about 40 inches (1 meter) from the unmasked eye. Ask the patient to fix constantly on your eye. Close your own left eye; fix your right on the patient's unmasked eye. Hold your right hand off to the side in the midplane between your faces. With flicking finger or penlight for a target, bring it slowly toward the midline between you. Ask the patient to indicate when the target first appears and compare with your own experience. Test vertical and oblique runs also. Test nasal field with left hand. Test the second eye similarly.