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

Station 03 — Pupillary Examination

4th Year • Eye • Rapid Revision • Practical Skills • Viva

🎯 Candidate Task

Examine this patient’s pupils, including assessment of the direct and consensual pupillary light reflexes. State your findings and identify any abnormal pupillary response.

⚡ Model Station Answer

  • I would inspect both pupils for size, shape and symmetry.
  • I would test the direct light reflex in each eye and then observe the opposite pupil for the consensual response.
  • Normally, illumination of either eye produces brisk constriction of both pupils.
  • I would report any anisocoria, irregular pupil, sluggish response or non-reactive pupil and compare both sides.

🔎 How to Perform / Approach

  1. Introduce and prepare. Confirm the patient, explain the examination, obtain consent and perform hand hygiene.
  2. Position correctly. Seat the patient comfortably at eye level and ask them to look at a distant target.
  3. Inspect the pupils. Compare both pupils for size, shape and symmetry before using the light.
  4. Reduce ambient light. Dim the room sufficiently to make pupillary constriction easier to observe.
  5. Test the direct response. Bring the penlight from the temporal side into one eye and observe constriction of that illuminated pupil.
  6. Test the consensual response. Shine the light into the same eye while observing the opposite pupil for simultaneous constriction; repeat from the other side.
  7. State the findings. Compare both sides and report whether the pupils and light responses are normal or abnormal.
Exam point: Keep the patient looking at a distant target and approach with the light from the side to reduce unwanted accommodation and allow the light response to be observed clearly.

🖼️ Visual Learning

VISUAL 1

Systematic Pupillary Examination: Inspection, Direct and Consensual Reflexes

🎥 Practical Demonstration

Pupillary Reflexes — OSCE Guide (Geeky Medics)
Practical demonstration of direct and consensual pupillary reflex examination suitable for undergraduate OSCE revision.

▶ Watch Practical Demonstration

📝 Important Viva Questions

1. What is the direct pupillary light reflex?

Answer: It is constriction of the pupil in the eye into which light is being shone.

2. What is the consensual pupillary light reflex?

Answer: It is constriction of the opposite pupil when light is directed into the other eye.

3. Which cranial nerves form the main afferent and efferent limbs of the pupillary light reflex?

Answer: The afferent limb travels through the optic nerve (CN II), while the parasympathetic efferent limb travels with the oculomotor nerve (CN III).

4. What constitutes a normal pupillary response to light?

Answer: Illumination of either eye should produce brisk constriction of both the illuminated and opposite pupils.

5. What abnormal findings should you look for during pupillary examination?

Answer: Look for unequal pupil size, abnormal shape, sluggish constriction or a pupil that does not react to light.

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