Eye Exam Cheat Sheet: Step-by-Step Assessment, Cranial Nerves, and How to Document It
A quick-reference guide to the basic eye exam taught in nursing, PA, and medical programs.
The basic eye exam in order: visual acuity → visual fields → external inspection → pupils (PERRLA) → extraocular movements → alignment → fundoscopy. This eye exam cheat sheet walks through each step with normal findings and documentation examples. Follow your program’s checklist for skills check-offs.
Eye assessment questions show up in health assessment courses, OSCEs, and nursing exams. This eye exam cheat sheet keeps the steps, cranial nerves, and terms in one place.
Eye Exam Cheat Sheet: Step by Step
| Step | How | Normal finding |
|---|---|---|
| Visual acuity | Snellen chart at the standard distance, one eye at a time, with corrective lenses if worn | Documented as a fraction, e.g., 20/20 |
| Near vision | Handheld card at reading distance | Reads small print comfortably |
| Visual fields | Confrontation test, comparing the patient’s fields to yours | Full to confrontation |
| External inspection | Lids, lashes, conjunctiva, sclera, cornea | Sclera white, conjunctiva clear, no discharge |
| Pupils | Size, shape, direct and consensual light reflex, accommodation | PERRLA |
| Extraocular movements | Follow your finger through the six cardinal fields of gaze (an “H” pattern) | EOMs intact, no nystagmus |
| Alignment | Corneal light reflex and cover-uncover test | Symmetric light reflex, no deviation |
| Fundoscopy | Ophthalmoscope: red reflex, optic disc, vessels | Red reflex present; disc margins sharp |
Cranial Nerves and Eye Muscles
- CN II (Optic): Visual acuity and visual fields; the afferent part of the pupillary reflex.
- CN III (Oculomotor): Most eye movements, eyelid elevation, and pupil constriction.
- CN IV (Trochlear): Superior oblique muscle — moves the eye down and in.
- CN VI (Abducens): Lateral rectus muscle — moves the eye outward.
- Memory trick — LR6 SO4: Lateral Rectus = CN 6, Superior Oblique = CN 4, all others = CN 3.
Common Abnormal Findings
| Term | Meaning |
|---|---|
| Anisocoria | Unequal pupil sizes |
| Ptosis | Drooping upper eyelid |
| Nystagmus | Involuntary, rhythmic eye movements |
| Strabismus | Misalignment of the eyes |
| Myopia / hyperopia | Nearsightedness / farsightedness |
| Presbyopia | Age-related difficulty with near vision |
| Absent red reflex | Needs prompt follow-up, e.g., for possible cataract or other conditions |
Sample Documentation
Example normal note: Visual acuity 20/20 OD, 20/20 OS without correction. Visual fields full to confrontation. Lids without lesions; conjunctiva clear; sclera white. PERRLA, 3 mm bilaterally. EOMs intact in all six fields without nystagmus. Corneal light reflex symmetric. Red reflex present bilaterally.
Abbreviations: OD = right eye, OS = left eye, OU = both eyes.
Key Takeaways
- Follow a consistent order: acuity, fields, external, pupils, EOMs, alignment, fundoscopy.
- Know what PERRLA stands for — and only chart it if you tested every part.
- Remember LR6 SO4 for the cranial nerves that move the eyes.
- Learn the key abnormal terms: anisocoria, ptosis, nystagmus, strabismus.
- Use OD, OS, and OU correctly in documentation.
Frequently Asked Questions
What are the steps of a basic eye exam?
A basic eye exam usually includes visual acuity, visual fields, external inspection, pupil assessment (PERRLA), extraocular movements, eye alignment, and fundoscopy.
What does PERRLA stand for?
PERRLA stands for Pupils Equal, Round, Reactive to Light and Accommodation.
Which cranial nerves control eye movement?
Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) control eye movement. A helpful mnemonic is LR6 SO4: lateral rectus is CN VI, superior oblique is CN IV, and the rest are CN III.
What do OD, OS, and OU mean?
OD means the right eye, OS means the left eye, and OU means both eyes.
The Bottom Line
This eye exam cheat sheet gives you a repeatable order, the key cranial nerves, and the terms you need to document clearly. Practice on classmates until the sequence feels natural.
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