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How to examine the eyes

Other platforms explain it with text and video. In Making Synapses you practice it on the patient.

MD / DOPANursing (NCLEX)
Practice it in VR with Blocky

The eye exam starts with vision: acuity is the vital sign of the eye. Then pupils, fields, movements and the back of the eye.

Step by step

  1. Prepare

    Clean your hands, introduce yourself and get consent. Ask about pain, redness, vision loss, flashes and floaters. [1]

  2. Visual acuity

    Snellen chart at 20 feet (6 m), one eye at a time, with glasses. Use a pinhole if vision is reduced. Record as 20/x. [1]

  3. Outside of the eye

    Eyelids, lashes, conjunctiva, sclera color and tearing. [1]

  4. Pupils

    Size, shape, direct and consensual reaction, accommodation, and the swinging flashlight test. [1]

  5. Visual fields and movements

    Confrontation test for fields; follow your finger in an H shape; corneal light reflex for alignment. [1]

  6. Fundoscopy

    Dim room. Your right eye for their right eye. Find the red reflex from about 15 inches, then follow it in to the optic disc, vessels and macula. [1]

  7. Red flags

    Sudden vision loss, a painful red eye, new flashes and floaters, and a fixed dilated pupil need urgent care. [2]

Common errors

Practice it in Making Synapses

In Making Synapses you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.

Making Synapses cases that train this skill

80 Making Synapses cases train this skill: open the case library

Sources

  1. Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
  2. NCCPA PANCE Content Blueprint

Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Facts and steps also follow NCCPA PANCE Content Blueprint. Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.