Anterior Segment and Posterior Segment Skills
"Hello I am Candidate _____ and I will be performing your examination today. Before I begin, I am going to wash my hands for 20 seconds and dry my hands completely. Normally, I will disinfect the tonometer tip and the gonioscopy lens, but it has already been cleaned for me today. I will now disinfect the slit lamp chin rest and forehead rest."
Count out loud how long you wash your hands for
Slit Lamp
Focus the slit lamp, set the tono probe, set the gonio lens
"I am going to use this microscope device to assess the health of the front part of your eyes. Please place your chin on the chin rest and forehead all the way against this bar."
LIDS
Set slit lamp to diffuse beam, 6-10x mag
"Please close your eyes. "
Begin scanning the lids and lashes ALL THE WAY
"I am looking at the upper and lower lids and lashes."
Normal: "Lids and lashes are clear."
"Please open your eyes. "
Assess upper and lower lid margins. Assess puncta. Go all the way out.
"I am now looking at the upper and lower margin. I am now looking at the puncta."
Normal: "Upper and lower lid margins are clear, puncta is patent"
CONJUNCTIVA
Scan the entire conjunctiva with bimanual movmement
"I will now assess the palpebral and bulbar conjunctiva"
"Please look to the left"
Normal: "Temporal bulbar conjunctiva is white and quiet"
"Patient, please look up to the sky. I am now everting the lower lid to look at the inferior bulbar and palpebral conjunctiva"
Proctor Protocol: The Do’s and Don’ts
Ask if you have a view - the right way: When you're in the hot seat, remember to ask your proctor if they have a view of the image. They'll let you know if they can see it, but don't expect them to be the quality police. If they say "no" -- don’t panic! Troubleshoot like a tech-savvy wizard. But if troubleshooting is turning into a saga, move along and come back to it.
Avoid Medical Slang: If you find yourself wanting to describe a structure with “OK,” “Fine,” “WNL,” or “not bad”—STOP RIGHT THERE! Channel your inner Shakespeare and be more descriptive. The eyes deserve better than casual chat!
Speak Up!: Remember, you’re not just performing for your proctor; you’re narrating the epic tale of your examination. Speak clearly and audibly!
Fleeting Views are Out: No quick glances—count to 3 seconds like you're waiting for your microwave popcorn to finish popping. Make sure you have a solid view before moving on.
Full Assessment Required: Don’t just skim the surface! When assessing the cornea, give it a complete scan. Pretend you're looking for buried treasure instead of just checking the center—those hidden gems could be hiding at the top and bottom behind the eyelids!
Camera Shenanigans: The camera is in the LEFT ocular - so, use your right eye if you have difficulty seeing through your left eye. It doesn't matter which eye you use as long as the camera sees it!