Procedure for Visual Field Tests
Visual Acuity Test- Assess clarity of vision using an eye chart (e.g., Snellen chart).
Equipment Needed: Snellen chart or equivalent.
Procedure:
Position the patient 20 feet away from the Snellen chart.
Instruct the patient to cover one eye (using an occluder or their hand) and read the smallest line
of letters they can see.
Record the result (e.g., 20/20, 20/40).
Repeat the test with the other eye.
If necessary, test with both eyes open.
Normal Findings:
Visual acuity of 20/20 in each eye.
Patient can read the smallest line on the Snellen chart without difficulty.
Abnormal Findings:
Visual acuity worse than 20/20 (e.g., 20/40, 20/200).
Difficulty reading letters or numbers on the chart, indicating potential refractive errors or
other visual impairments.
Extraocular Muscle Test - Evaluate eye movement and muscle function.
Procedure:
Ask the patient to sit comfortably and focus on a target (e.g., your finger).
Hold the target about 12 inches in front of the patient’s face.
Move the target in various directions (up, down, left, right, and diagonally) while observing the
movement of the eyes.
Ensure both eyes move together and smoothly without any nystagmus or strabismus.
Normal Findings:
Smooth and coordinated eye movements in all directions.
No nystagmus (involuntary eye movement) or strabismus (misalignment of the eyes).
Abnormal Findings:
Limited movement in one or more directions.
Presence of nystagmus or strabismus, indicating possible cranial nerve dysfunction or muscle
weakness.
Corneal Light Reflex- Check for symmetry of light reflection on the corneas to assess alignment.
Procedure:
Position the patient in front of you at eye level.
Shine a penlight or flashlight directly at the patient’s eyes from about 12-15 inches away.
Observe the reflection of the light on the corneas.
The light reflection should be symmetrical in both eyes. If not, it may indicate strabismus or
misalignment.
Normal Findings:
Light reflection is symmetrical on both corneas.
Abnormal Findings:
Asymmetrical light reflection, indicating possible strabismus or misalignment of the eyes.
Cardinal Positions of Gaze -Instruct the patient to follow a target in all six cardinal positions to assess
cranial nerves III (Oculomotor), IV (Trochlear), and VI (Abducens).
Procedure:
Ask the patient to keep their head still and follow your finger or a penlight with their eyes.
Move the target in the shape of an "H" or "X" to assess all six cardinal positions of gaze.
Observe for any limitations in movement or nystagmus.
Note any cranial nerve involvement (Cranial Nerves III, IV, VI).
Normal Findings:
Eyes move smoothly and symmetrically in all six cardinal positions of gaze.
No nystagmus or double vision (diplopia).
Abnormal Findings:
Limited movement in one or more directions.
Nystagmus or diplopia, suggesting cranial nerve dysfunction or muscle imbalance.
PERRLA (Pupils Equal, Round, Reactive to Light and Accommodation)- Assess pupil size, shape, and
reaction to light and accommodation.
Procedure:
Dim the lights in the room to enhance pupil response.
Use a penlight to shine into one eye and observe the reaction of that pupil (constriction).
Quickly move the light to the other eye and observe the same reaction.
Check for accommodation by having the patient focus on a distant object and then a near object
(e.g., your finger).
Note if both pupils constrict when focusing on the near object.
Normal Findings:
Pupils are equal in size (approximately 2-6 mm), round, and reactive to light and
accommodation.
Both pupils constrict when exposed to light and accommodate when focusing on a near object.
Abnormal Findings:
Unequal pupil size (anisocoria).
Non-reactive pupils or sluggish response to light.
Lack of accommodation response, indicating potential neurological issues.
Test Hearing (Cranial Nerve VIII) -Conduct a voice test to evaluate auditory function.
Procedure:
Stand about 1-2 feet away from the patient.
Ask the patient to cover one ear.
Whisper a series of numbers or words and ask the patient to repeat them.
Repeat the test with the other ear.
Normal Findings:
Patient can accurately repeat whispered numbers or words from a distance of 1-2 feet.
Abnormal Findings:
Inability to hear or repeat whispered words, indicating possible hearing loss or auditory nerve
issues.
Weber Test- Equipment Needed: Tuning fork (512 Hz is commonly used).
Use a tuning fork to assess lateralization of sound.
Procedure:
Strike the tuning fork to make it vibrate.
Place the base of the tuning fork on the center of the patient’s forehead or the top of their
head.
Ask the patient where they hear the sound (in one ear, both ears, or if it is louder in one ear).
Normal hearing will result in sound being heard equally in both ears.
Normal Findings:
Sound is heard equally in both ears (no lateralization).
Abnormal Findings:
Sound lateralizes to one ear, indicating possible conductive hearing loss in the ear where the
sound is louder or sensorineural hearing loss in the opposite ear.
Rinne Test- Compare air conduction to bone conduction using a tuning fork to evaluate hearing
loss.Equipment Needed: Tuning fork (512 Hz).
Procedure:
Strike the tuning fork to make it vibrate.
Place the base of the tuning fork on the patient’s mastoid bone (behind the ear) and ask them to
indicate when they can no longer hear the sound.
Once they can no longer hear it, quickly move the tuning fork in front of the ear canal (without
touching) and ask if they can hear it again.
Compare the duration of sound heard through bone conduction (BC) vs. air conduction (AC).
Normally, AC should be greater than BC (Rinne positive).
Normal Findings:
Air conduction (AC) is greater than bone conduction (BC) (Rinne positive), indicating normal
hearing.
Abnormal Findings:
Bone conduction is greater than air conduction (Rinne negative), indicating conductive hearing
loss.
If both AC and BC are diminished, it may suggest sensorineural hearing loss.
