Introduction To Optometry: The Normal Eye

INTRODUCTION TO OPTOMETRY
The normal eye

Authors
Brien Holden Vision Institute Faculty
Sydney, Australia
Peer Reviewer
Bob Chappell
Past President: World Council of Optometry (WCO)
Project Director, Editor-in-Chief

Luigi Bilotto
Brien Holden Vision Institute, Public Health Division, Durban, South Africa
University of Montreal, Quebec, Canada

Associate Editor
Pirindhavellie Govender
Brien Holden Vision Institute, Public Health Division, Durban, South Africa
University of KwaZulu Natal (UKZN) Durban, South Africa

Technical Editors
Vicky Larochelle, Raheema Ayob, Vicki Evans, Elaine Quinn, Kerryn Hart

Layout Editors
Rajni Chhabra, Prashant Kumar

Graphics
Shane Parker
Brien Holden Vision Institute Foundation (formerly ICEE) is a Public Health division of Brien Holden Vision Institute
COPYRIGHT © 2010 Brien Holden Vision Institute. All rights reserved.
This publication is protected by laws relating to copyright. Except as permitted under applicable legislation, no part of this publication may be adapted, modified, stored in a retrieval system, transmitted or reproduced in any form or by any process, electronic or otherwise,
without the Brien Holden Vision Institute’s (The institute) prior written permission. You may, especially if you are from a not-for-profit organisation, be eligible for a free license to use and make limited copies of parts of this manual in certain limited circumstances. To see if you
are eligible for such a license, please visit http://education.brienholdenvision.org/ .
DISCLAIMER
The material and tools provided in this publication are provided for purposes of general information only. The Institute is not providing specific advice concerning the clinical management of any case or condition that may be mentioned in this publication, and the information
must not be used as a substitute for specific advice from a qualified professional.
The mention of specific companies or certain manufacturers’ products does not imply that those companies or products are endorsed or recommended by the Institute in preference to others of a similar nature that are not mentioned. The Institute makes no representation or
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Learning outcomes
• Recognise a normal, healthy eye

External eye exam
Eyelids
Conjunctiva
Cornea
Pupils
Eyelids
• To examine the eyelids, you need to look

at the skin of the eyelids and the lid margin
Healthy eyelids
• Open and close properly

• Look clean
• Look smooth
• Lashes turn away from eyeball
• Do not look red, puffy
or swollen
• Right and left upper lids
are symmetrical
• No drooping lid
Eyelid conjunctiva
• To see the palpebral conjunctiva, we need

to evert the eyelid.
Healthy palpebral conjunctiva
• Looks pink, not red

• Clear with a few small blood
vessels
• No lumps or growths
• No pus
• No foreign bodies
(like sand or grit)
Sclera and Bulbar conjunctiva
To look at the sclera and bulbar conjunctiva:

• Gently hold the eyelids
open using your thumb
and first finger
• Use your thumb to hold the
bottom eyelid against their
cheek and your first finger
to hold the upper eyelid
against the brow.
Healthy bulbar conjunctiva
• Should be transparent
and smooth
• Allows a clear view of
the white sclera
• Has only a few small blood
vessels, red parts
• No pus, watering or bleeding
Cornea
Healthy cornea
• Clear and smooth

• No scars
• Allows a clear view
of the iris
• No blood vessels
and no red parts
Pupils
• Pupils should be equal in size and reactive to
light
• Unequal pupils or pupils that do not respond to
light can sometimes be a sign of serious
problem.
• Consider size, colour, response
PUPIL
Normal pupils
• Black, not grey or white

• The same size
• Round
• Get smaller when
a light is shone into either eye
• Get bigger when
the light is taken away
Internal eye exam
Lens
Retina
Macula
Optic Nerve
Normal crystalline lens
• Clear, not cloudy or

discoloured as seen
here.
• No dark areas in the

photo courtesy of the WHO
fundus reflex
• Located behind the iris,

not in the anterior
chamber
Normal vitreous chamber
• Clear
• Contains no blood
• No new blood vessels
• No dark spots or shapes
Vitreous chamber containing vitreous

Healthy retina
• One solid shade of red

• Blood vessels are intact
and not leaking
• No signs of blood
haemorrhages
• No areas of discolouration
• No signs of rips or tears
or detachment
Healthy macula
• Clear and flat

• No blood leakage
• No areas of discolouration
• No holes or tears
• Might see a foveal reflex
in young people
Macula
Healthy optic nerve head
• Round
• Flat, not swollen
or elevated
• C:D ratio no larger
than 0.5
• Pink, not pale in colour
• Well defined edges
• No haemorrhages

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INTRODUCTION TO OPTOMETRY

The normal eye

Project Director, Editor-in-Chief

COPYRIGHT © 2010 Brien Holden Vision Institute. All rights reserved.

• Recognise a normal, healthy eye

• To examine the eyelids, you need to look

• Open and close properly

• To see the palpebral conjunctiva, we need

• Looks pink, not red

To look at the sclera and bulbar conjunctiva:

• Clear and smooth

• Black, not grey or white

• Clear, not cloudy or

• No dark areas in the

• Located behind the iris,

Vitreous chamber containing vitreous

• One solid shade of red

• Clear and flat

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