Initial Assessment of the Eye

Author: Jonathan D Whittaker / Editor: Tajek B Hassan / Reviewer: Caitriona Considine, Louise Burrows / Codes: CAP29, HAP32, PAP16 / Published: 29/03/2021


This session covers the initial assessment of eye and visual problems in the Emergency Department (ED).

After completing this session you will be able to:

  • Record visual acuity accurately in a variety of different clinical situations
  • Interpret changes in pupillary size, shape and reaction in acute eye problems
  • Recognise common visual field defects and identify the site of the causative lesion
  • Evaluate the diagnostic ocular preparations used in the initial assessment of the eye


  1. Handbook of Ocular Disease Management. View website
  2. Edwards RS. 1987. Ophthalmic emergencies in a district general hospital casualty department. Br J Ophthalmol; 71:938-942
  3. Bhopal RS, Parkin DW, Gillie RF, 1991. Pattern of ophthalmological accident and emergencies presenting to hospitals. J Epidemiol Community Health 1993; 47:382-7
  4. Clancy MJ, Hulbert M. A study of the eye care provided by an accident and emergency department. Arch Emerg Med; 8:122-4
  5. Tan MMS, Driscoll PA, Marsden JE. 1997. Management of eye emergencies in the accident and emergency department by senior house officers: a national survey. J Accid Emerg Med; 14:157-8
  6. Flitcroft DI, Westcott M, Wormald R, 1995. Who should see eye casualties?: a comparison of eye care in an accident and emergency department with a dedicated eye casualty. J Accid Emerg Med; 12:23-7
  7. Ezra DG, Mellington F, Cugnoni H, 2005. Reliability of ophthalmic accident and emergency referrals; a new role for the emergency nurse practitioner? Emerg Med J; 22: 696-9
  8. Rietveld RP, van Weert HC, ter Riet G, 2003. Diagnostic impact of signs and symptoms in acute infectious conjunctivitis: systematic literature search. BMJ; 327: 789
  9. Pandit JC. 1994. Testing acuity of vision in general practice: reaching recommended standard. BMJ; 309:1408
  10. Gilbert M, Hopkinson RG. 1949. The illumination of the Snellen chart. Br J Ophthalmol; 33: 305-310
  11. BS 4274: 1968. Specification for test charts for determining distance visual acuity. London: British Standards Institution, 1968
  12. McGraw P, Winn B, Whitaker D. 1995. Reliability of the Snellen chart. BMJ; 310:1481-2
  13. Hussain B, Saleh GM, Sivaprasad S, 2006. Changing from Snellen to LogMAR: debate or delay. Clin Experiment Ophthalmol; 34:6-8
  14. Witting MD, Goyal D. 2003. Normal pupillary size in fluorescent and bright light. Ann Emerg Med; 41:247-50
  15. Witting MD, Goyal D. 2003. Interrater reliability in pupillary measurement. Ann Emerg Med; 41:832-7
  16. Lam BL, Thompson HS, Corbett JJ. 1987. The prevalence of simple anisocoria. Am J Ophthalmol; 104:69-73
  17. Lam BL, Thompson HS, Walls RC. 1996. Effect of light on the prevalence of simple anisocoria. Ophthalmology; 103:790-3
  18. Rose GE, Pearson RV. 1991. Unequal pupil size in patients with unilateral red eye. BMJ; 302: 571-2
  19. Peterson RC, Wolffsohn JS, Fowler CW. 2006. Optimization of anterior eye fluorescein viewing. Am J Ophthalmol; 142:572-5
  20. Weaver CS, Rusyniak DE, Brizendine EJ, 2003. A prospective, randomized, double-blind comparison of buffered versus plain tetracaine in reducing the pain of topical ophthalmic anesthesia. Ann Emerg Med; 41:827-831
  21. Steffen J, Batrick N. 2008. Proxymetacaine is the local anaesthetic of choice for removal of corneal foreign bodies. Best BETs. View link
  22. Klein R, Klein BE, Neider MW, 1985. Diabetic retinopathy as detected using ophthalmoscope, a nonmydriatic camera and a standard fundus camera. Ophthalmology; 92:485-91
  23. Pandit RJ, Taylor R. 2000. Mydriasis and glaucoma: exploding the myth. A systematic review. Diabetic Med; 17:693-9

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