Ophthalmic Education:

Principles and Guidelines of a Curriculum for Ophthalmic Education of Medical Students: Chapter II: Fundamentals and Principles of Ophthalmology

On this page:

• Educational Goal
  
  
• Clinical Competencies

Educational Goal:

Medical students should recognize external and internal ocular structures of the normal human eye and know how to perform a basic eye examination. 

Students should:

• Describe normal ocular anatomy.* (REF. 2E Slide 58, 59;) (REF. 22 Fig. G02)
  
  
• Obtain an accurate and complete ocular history.* (REF. 2B Slide 14)
  
  
• Measure and record near visual acuity in an adult with near correction and understand principles of distance acuity measurement in adults and children.*
  
  
• Assess pupillary reflexes.*
  
  
• Evaluate ocular motility.* (REF. 4 Table 1.2 and Figure 6.10)
  
  
• Use the direct ophthalmoscope for assessment of red reflex, the optic nerve, and posterior fundus examination.*  (REF. 22 Fig. I03)
  
  
• Dilate the pupils.*
  
  
• Perform and evaluate visual fields by confrontation.*

A. Ocular Anatomy.*

Students should be able to define each of these structures and describe their function.

(REF. 4 Fig. 1.1, 1.2)

1. Eyelids.*

2. Sclera.*

3. Limbus.*

4. Iris.* (REF. 2E Slide 58)

5. Pupil.*

6. Conjunctiva.*

7. Cornea.* (REF. 2E Slide 58, 59)

8. Extraocular muscles.*

9. Anterior chamber.* (REF. 2E Slide 58)

10. Lens.* (REF. 2E Slide 58)

11. Ciliary body.* (REF. 2E Slide 58)

12. Posterior chamber.*

13. Vitreous cavity.*

14. Retina.* (REF. 4 Fig. 1.15)

15. Macula.*

16. Choroid.*

17. Optic nerve.* (REF. 24 Slide 3)

B. Visual Acuity.*  

1. Students should understand the purpose of measuring near visual acuity with and without correction and testing each eye individually.* (REF. 2E Slide 7) (REF. 4 Fig. 1.8)

2. Students should understand the concept of distance visual acuity testing with and without correction and with a pinhole. Students are not expected to perform refraction.* (REF. 4 Table 1.1)

C. External Inspection.* (REF. 22 Fig. G36, G40, G44)

Students should understand the external ocular anatomy, evaluate the position of the lids, and inspect the conjunctiva, sclera, cornea, and iris with a penlight.

D. Pupillary Reaction Testing.*  (REF. 24 Slide 11)

Students should measure the pupillary size and assess the direct and consensual pupillary reaction.

E. Ocular Motility Testing.*  

Students should understand the importance of assessing ocular motility in the six cardinal positions of gaze and ocular alignment in primary position.

F. Direct Ophthalmoscopy.*  

Students should understand the basic function of an ophthalmoscope and should know how to adjust focus.  Students should know the importance of the relationship between which examiner’s hand is used to examine the patient’s right or left eye.

G. Pupillary Dilatation.*  (REF. 22 Fig. J05)

Students should understand how to pharmacologically dilate pupils for examination of the ocular fundus.  Students should understand the difference between retinal arterioles and retinal venules, the normal appearance of  the optic nerve head, retinal pigment epithelium, and foveal reflex.  Student should also recognize the normal uniform red-orange background retinal color due to retinal pigment epithelium and choroid.

H. Intraocular Pressure Measurement.* (REF. 22 Fig. C29, C30)

Students should understand the concept of assessing intraocular pressure, but are not expected to measure intraocular pressure with a tonometer.

I.  Anterior Chamber Depth Assessment.* (REF. 4 Fig. 1.10)

Students should understand how to assess anterior chamber depth with a penlight held at an oblique angle to the optical axis.

J.  Confrontation Field Testing.*

Students should understand the principle and technique of determining the peripheral visual field by the finger counting confrontation technique.

K. Upper Lid Eversion.* (REF. 4 Fig. 1.9)

Students should know how to evert the upper lid and examine for the presence of foreign bodies.

L. Fluorescein Staining of the Cornea.*  (REF. 2E Slide 61-63)

Students should know how to apply topical fluorescein and interpret staining of the cornea for detection of a corneal epithelial defect. (REF. 4 Fig. 1.12 and 1.13)

M. Indications for Referral.*  

Students should know when to refer patients to an ophthalmologist for evaluation of suddenly reduced visual acuity, abnormal fundus appearance, and other abnormal findings associated with serious ocular or systemic disease.

Clinical Competencies

Students should:

• Understand basic ocular anatomy.*
• Measure near visual acuity.*
• Test for direct, consensual, and afferent pupillary reactions.*
• Understand the rationale and interpretation of testing the red reflex.*
• Understand the importance of the dilated fundus examination.*
• Understand and perform direct ophthalmoscopy.*
• Understand normal fundus appearance of the optic disc, macula, and major vessels
• Understand important causes of reduced vision, abnormal fundus appearance, and abnormal findings that require referral of the patient to an ophthalmologist for evaluation.*

Next: III. Cornea and External Diseases

Also see:

• Table of Contents of the "Principles and Guidelines of a Curriculum for Ophthalmic Education of Medical Students"
  
  
• Education of Medical Students in Ophthalmology
  
  
• Resources for Ophthalmic Education of Medical Students