Start with clarifying patients details and asking if the patient wears glasses. If so are they used to correct short or long sightedness.
Test for visual acuity from 6 metres using Snellen chart. Test both eyes individually. Ask them to read the lowest line they can.
If the patient is unable to read then they can move closer by 3 metres.
If still unable to read then move closer again by another metre.
If still unable to read then assess by counting number of fingers or assess ability to detect a moving hand.
If not able to do any of that then assess light perception.
Assess for near vision asking patient to read a sentence from a book for example. If they wear glasses for reading these should be kept on.
Test visual fields using confrontation. Sit opposite patient, ask them to cover one aye and you cover the opposite eye. Hold arm outstretched to the side and wiggle fingers asking patient if they see it. Move hand in slowly as you do it. Test all visual areas.
Examine pupils for size, shape and symmetry.
Assess for direct and consensual pupillary response.
Have the room as dark as possible when doing these tests.
Assess convergence. Ask patient to look at your finger tip which should be approx 8- 10 inches away from patient. Then ask them to look at wall behind you. Pupils should constrict and dilate as they move between the two.
Assess for eye movement.
Patient should keep their head still as they follow the tip of your finger which you trace in an H pattern in front of them. You should observe for any nystagmus and you should ask the patient if they have any double vision.
Examine the back of both eyes using opthalmoscope.
Shine light into patients eye trying to elicit red eye reflex- absence may indicate cataracts or retinoblastoma.
Pupils should be dilated and an attempt should be made to observe firstly the nasal retina to observe the optic disc. You should look for colour (a pale disc may indicate neuritis/ischaemia)
contour (poorly defined border may indicate papilloedema)
and cupping (increased cup to disc ratio is observed in glaucoma)