Course Content
👁️ Station 1 — Ophthalmic History Taking
• Take a structured history from a patient presenting with an ocular complaint. • Identify the chief ocular complaint and its duration. • Explore relevant associated ocular symptoms. • Obtain relevant previous ocular, medical and treatment history. • Present the important findings of the ocular history in a concise clinical format.
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Topic: 👁️ Station 1 — Ophthalmic History Taking
🔤 Station 2 — Visual Acuity Examination
• Correctly position the patient and visual-acuity chart. • Assess distance visual acuity in each eye separately. • Record visual acuity correctly. • Use pinhole assessment where appropriate. • Interpret an abnormal visual-acuity result.
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Topic: 🔤 Station 2 — Visual Acuity Examination
🔦 Station 3 — Pupillary Examination
• Inspect pupil size, shape and symmetry. • Assess direct pupillary light reflex. • Assess consensual pupillary light reflex. • Assess the pupillary response systematically. • Recognize an abnormal pupillary response.
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Topic: 🔦 Station 3 — Pupillary Examination
👀 Station 4 — Visual Field Examination by Confrontation
• Position the patient correctly for confrontation testing. • Examine each eye separately. • Assess the major visual-field quadrants systematically. • Compare the patient's visual field with the examiner's field. • Identify the presence of a gross visual-field defect.
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Topic: 👀 Station 4 — Visual Field Examination by Confrontation
🔬 Station 5 — Slit-Lamp and Anterior Segment Examination
Integrated KMU activities: 5. Slit-Lamp Examination 6. Anterior Segment Examination Learning Objectives The student should be able to: • Identify the major parts/components of a slit lamp. • Explain the basic purpose of slit-lamp examination. • Position the patient appropriately. • Examine the anterior segment systematically using the slit lamp. • Identify important anterior-segment structures during examination.
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Topic: 🔬 Station 5 — Slit-Lamp and Anterior Segment Examination
🩺 Station 6 — Direct Ophthalmoscopy and Fundus Examination
• Demonstrate correct handling of the direct ophthalmoscope. • Position themselves and the patient appropriately. • Perform direct ophthalmoscopy systematically. • Visualize the optic disc and retinal background. • Describe important fundus findings seen during examination.
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Topic: 🩺 Station 6 — Direct Ophthalmoscopy and Fundus Examination
📊 Station 7 — Interpretation of Common Ophthalmic Investigations
The student should be able to: • Identify a presented ophthalmic investigation. • Describe the basic information provided by OCT. • Interpret common visual-field findings. • Recognize the role/output of ocular biometry. • Interpret basic B-scan findings. • Recognize FFA and corneal-topography images and state their clinical use.
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Topic: 📊 Station 7 — Interpretation of Common Ophthalmic Investigations
👁️ Station 8 — Ptosis Examination
• Inspect a patient with suspected ptosis. • Compare eyelid position between both eyes. • Perform a systematic clinical assessment of ptosis. • Identify important abnormal findings. • Record and communicate the findings appropriately.
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Topic: 👁️ Station 8 — Ptosis Examination
👓 Station 9 — Examination of Common Lid Abnormalities
• Examine the eyelids systematically. • Recognize ectropion. • Recognize entropion. • Identify chalazion. • Identify stye. • Differentiate common lid abnormalities from one another on clinical examination or photographs.
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Topic: 👓 Station 9 — Examination of Common Lid Abnormalities
👁️ Station 10 — Proptosis Examination
• Recognize the presence of proptosis. • Compare both eyes for symmetry. • Perform a structured ocular examination in a patient with proptosis. • Assess relevant associated ocular findings. • Present the examination findings systematically.
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Topic: 👁️ Station 10 — Proptosis Examination
💧 Station 11 — Topical Anaesthesia, Fluorescein Staining and Corneal Assessment
• Demonstrate appropriate use of topical ocular anaesthesia. • Demonstrate fluorescein staining of the ocular surface. • Examine the stained cornea appropriately. • Identify a superficial corneal abnormality/foreign body when presented. • Explain the purpose of corneal scraping in suspected corneal infection.
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Topic: 💧 Station 11 — Topical Anaesthesia, Fluorescein Staining and Corneal Assessment
💦 Station 12 — Lacrimal Regurgitation Test
• Explain the purpose of the lacrimal regurgitation test. • Position the patient appropriately. • Perform the test correctly. • Observe for reflux from the lacrimal puncta. • Interpret a positive or negative result.
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Topic: 💦 Station 12 — Lacrimal Regurgitation Test
🚨 Station 13 — Ocular Trauma and Chemical Eye Injury First Aid
• Perform an initial assessment of an ocular-trauma patient. • Identify the need for urgent eye first aid. • Demonstrate immediate management of chemical eye injury. • Perform appropriate eye irrigation/eye wash. • Explain essential precautions during initial ocular-trauma management.
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Topic: 🚨 Station 13 — Ocular Trauma and Chemical Eye Injury First Aid
🔍 Station 14 — Optic Disc Examination: Normal, Glaucomatous and Swollen Disc
• Identify and describe a normal optic disc. • Examine or interpret the optic disc systematically. • Recognize features of a glaucomatous disc. • Recognize a swollen optic disc. • Differentiate a normal disc from major abnormal disc appearances.
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Topic: 🔍 Station 14 — Optic Disc Examination: Normal, Glaucomatous and Swollen Disc
🩸 Station 15 — Retinal Lesions and Retinal Vascular Disease
• Inspect a retinal photograph/fundus image systematically. • Detect common retinal abnormalities. • Recognize common retinal vascular abnormalities. • Differentiate common retinal vascular conditions from one another. • Describe the important visual findings presented.
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Topic: 🩸 Station 15 — Retinal Lesions and Retinal Vascular Disease
⚠️ Station 16 — Recognition of Retinal Detachment
• Recognize retinal detachment in a clinical image. • Describe the abnormal retinal appearance. • Distinguish detached retina from a normal retinal appearance. • Identify retinal detachment as a significant cause of visual loss. • Communicate the finding clearly in an OSCE setting.
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Topic: ⚠️ Station 16 — Recognition of Retinal Detachment
📈 Station 17 — Tonometry and Glaucoma Assessment
• Identify the Goldmann applanation tonometer. • Explain the purpose of tonometry. • Describe the basic method of Goldmann tonometry. • Interpret an intraocular-pressure reading in the clinical context. • Relate tonometry to assessment of glaucoma.
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Topic: 📈 Station 17 — Tonometry and Glaucoma Assessment
🌫️ Station 18 — Cataract Examination and Recognition
• Perform a basic ocular assessment for cataract. • Recognize the presence of cataract on ocular examination. • Describe the abnormal lens appearance. • Differentiate a clear lens from a cataractous lens. • Recognize adult and congenital cataract when presented clinically or visually.
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Topic: 🌫️ Station 18 — Cataract Examination and Recognition
↔️ Station 19 — Extraocular Movements and Ocular Motor Examination
• Inspect ocular alignment. • Examine extraocular movements systematically. • Test the major directions of gaze. • Identify limitation of ocular movement. • Recognize an abnormal ocular-motility pattern during examination.
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Topic: ↔️ Station 19 — Extraocular Movements and Ocular Motor Examination
🔁 Station 20 — Squint Examination: Cover Tests and Squint Pattern
• Assess ocular alignment. • Perform the cover test. • Perform the uncover test. • Perform the alternate-cover test. • Identify the presence of manifest or latent deviation from the examination. • Differentiate an esotropia pattern from an exotropia pattern.
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Topic: 🔁 Station 20 — Squint Examination: Cover Tests and Squint Pattern
AIM OSPE/OSCE Lab — Ophthalmology Module | 4th Year MBBS

AIM OSCE / OSPE • MBBS • 4th Year • Eye
Station 19 — Extraocular Movements and Ocular Motor Examination

Rapid Revision • Practical Skills • Viva

🎯 Candidate Task

Examine this patient’s ocular alignment and extraocular movements systematically. Demonstrate the major directions of gaze and report any abnormal ocular-motility finding you identify.

⚡ Model Station Answer

  • The eyes are inspected for alignment in the primary position.
  • I assess conjugate extraocular movements through the major directions of gaze using an H-pattern.
  • I look for restriction or asymmetry of movement and ask about diplopia during testing.
  • I also observe for nystagmus in the different gaze positions.
  • If abnormal, I would state the affected eye and the specific direction in which movement is limited.

🔎 How to Perform / Approach

  1. Prepare the patient. Perform hand hygiene, introduce yourself, obtain consent and seat the patient upright at eye level.
  2. Inspect primary gaze. Ask the patient to look straight ahead and compare the position and alignment of both eyes.
  3. Position the target. Hold your finger or a small target about 30 cm in front of the patient’s eyes and ask them to keep their head still.
  4. Test ocular movements. Ask the patient to follow the target with their eyes only while moving it slowly through a large H-pattern to assess the major directions of gaze.
  5. Observe carefully. Compare both eyes for conjugate movement, asymmetry, restriction or failure of an eye to reach a particular gaze position; ask whether diplopia or pain occurs.
  6. Check abnormal movements. Observe for nystagmus, particularly when the eyes are held briefly in the lateral gaze positions.
  7. Report the finding. State whether movements are full and conjugate or specify the affected eye and direction of restricted movement.
Exam point: Move the target rather than the patient’s head. A limitation should be described precisely by eye + direction of gaze before attempting anatomical localization.

🖼️ Visual Learning

VISUAL 1

Systematic Extraocular Movement Examination

 

🎥 Practical Demonstration

▶
Testing Extraocular Movements — Close-Up Demonstration
Clinical Neurological Sciences • Schulich School of Medicine & Dentistry, Western University

Watch Practical Demonstration

📝 Important Viva Questions

1. Why is an H-pattern used during extraocular movement examination?

Answer: It allows systematic assessment of the major directions of gaze and helps reveal restriction or asymmetry of ocular movement.

2. Which cranial nerves control the extraocular muscles?

Answer: Cranial nerves III, IV and VI: the oculomotor, trochlear and abducens nerves.

3. Which muscle is primarily responsible for abduction of the eye?

Answer: The lateral rectus muscle, supplied by the abducens nerve (CN VI).

4. What should you ask the patient while testing eye movements?

Answer: Ask the patient to report any double vision or pain while following the target.

5. How should an abnormal ocular movement be reported in an OSCE?

Answer: State which eye is affected and the exact direction in which movement is restricted; also mention associated diplopia or nystagmus if present.

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