Day 1 in the Eye OPD: Pocket Checklist for Junior Residents

Last updated: November 2026

Your first day in the eye OPD: what to carry, the order to examine in, what to write, which patients must not go home, and the mistakes juniors make. Print it as a pocket card or keep it open on your phone.

Before clinic: what to carry

• Pen torch, near vision chart and pinhole occluder
• Direct ophthalmoscope; 90 D or 78 D lens (and 20 D if you will use the indirect)
• Fluorescein strips, topical anaesthetic drops (for examination only)
• Red-top object (bottle cap) for colour desaturation and fields
• Ishihara book access, Amsler grid, millimetre ruler
• A notebook or phone list of senior and on-call numbers, and the referral pathway for retina, glaucoma, cornea, paediatrics, oculoplasty and neuro clinics

The examination sequence (every patient)

1. Vision first, each eye separately, with glasses and pinhole; near vision if over 40. Never skip it, even in an emergency (except chemical injury: irrigate first).
2. Pupils before any drops: size, reaction, and swinging-torch test for RAPD.
3. Ocular movements and alignment; cover test if a squint or diplopia is reported.
4. Confrontation fields when the history suggests a neurological or glaucoma problem.
5. Slit lamp from front to back: lids and lashes, conjunctiva, cornea (with fluorescein if red or painful), anterior chamber depth (van Herick) and cells, iris, lens.
6. IOP (after fluorescein and anaesthetic); avoid applanation on an infected or perforated cornea.
7. Fundus: disc, macula and vessels, dilated if indicated and safe.

A documentation template you can copy

Name / Age / Sex / OPD No.
Chief complaint (eye, duration):
History: onset, progression, pain, redness, discharge, photophobia, floaters/flashes, diplopia
Past ocular: glasses, surgery, laser, trauma, drops
Systemic: DM, HTN, asthma, thyroid, steroids, anticoagulants, allergies

            RE            LE
VA (pinhole)
Near vision
Pupils / RAPD
Lids & adnexa
Conjunctiva
Cornea (+ stain)
AC (depth, cells)
Iris
Lens
IOP (method, time)
Fundus (disc, CDR, macula, periphery)

Impression:
Plan: investigations / treatment (drug, eye, frequency, duration) / follow-up date / red-flag advice given

Always write which eye (RE / LE, never just "the eye"), the time of IOP measurement, the drug strength, and the follow-up date. If you did not see the fundus, write "fundus not seen" and why.

Do not send home without a senior review

Never do

• Never prescribe topical anaesthetic drops for home use: they cause non-healing ulcers and corneal melt.
• Never start steroid drops for a red eye without a slit lamp and fluorescein examination: they can turn a herpetic dendrite or fungal ulcer into a perforation.
• Never dilate a patient before checking the pupils and anterior chamber depth, or a patient under neurological observation without the neurosurgeon's agreement.
• Never pad an eye with a suspected infection, or apply pressure to an eye that may be open.
• Never label a red eye "conjunctivitis" if vision is reduced, the eye is painful or photophobic, or the cornea stains.
• Never prescribe timolol without asking about asthma and heart block.
• Never let a patient leave without knowing when to come back and which symptoms mean "come back today".

Dilating safely

• Usual adult regimen: tropicamide 1% with phenylephrine 2.5%, one drop each, repeated after 10 minutes if needed; full dilation in 20–30 minutes.
• Check the anterior chamber depth (van Herick) first. A shallow angle is not an absolute bar, but warn the patient about pain and blurred vision and check the IOP before they leave if you are worried.
• Use phenylephrine with care in patients with uncontrolled hypertension or heart disease, and lower strengths in infants.
• Tell patients not to drive until the blur wears off (usually 4–6 hours).

Asking for help and handing over

• Use SBAR when you call a senior: Situation (who and what), Background (relevant history), Assessment (your findings, including vision and IOP), Recommendation (what you need: review, advice, theatre).
• Write down what the senior advised, with their name and the time.
• Hand over every patient still waiting for a result or review at the end of clinic.

Next reads: History taking and case presentation, The eye examination, Ophthalmic emergencies, Clinic desk reference, Referral guide, Viva hot seat.