🧼 Hand Hygiene: Wash your hands thoroughly before starting.
🙂 Patient Introduction: Introduce yourself, confirm name and DOB, and explain the procedure.
📝 Consent & Explanation: Gain consent and explain you will test their side vision (peripheral vision).

🧰 Equipment Needed

📏 Snellen chart (mainly for central vision, if needed).
✏️ A pen, finger, or small target for confrontation testing.
💡 A well-lit room with plain background.
🎯 A fixation target (usually the examiner’s nose).

⚠️ Common OSCE errors:
– Not testing each eye separately (always occlude one eye 👁️).
– Homonymous hemianopia 👉 usually stroke affecting opposite hemisphere.
– Bitemporal hemianopia 👉 usually pituitary macroadenoma compressing the chiasm.

👀 Visual Field Defects

👓 Bitemporal Hemianopia
- Description: Loss of outer (temporal) fields in both eyes.
- Common Cause: Pituitary adenoma compressing the optic chiasm.
↔️ Homonymous Hemianopia
- Description: Loss of the same half of the visual field in both eyes.
- Common Causes: Stroke, tumour, or lesion in optic tract, optic radiations, or occipital cortex.
⬆️ Homonymous Superior Quadrantanopia
- Description: “Pie in the sky” – loss of the upper quadrant of the visual field.
- Common Cause: Temporal lobe lesion (Meyer’s loop involvement).
⬇️ Homonymous Inferior Quadrantanopia
- Description: “Pie on the floor” – loss of the lower quadrant of the visual field.
- Common Cause: Parietal lobe lesion.
🎯 Central Scotoma
- Description: Loss of central vision, blind spot in the middle of vision.
- Common Causes: Optic neuritis (MS), Leber’s optic neuropathy.

🪜 Step-by-Step Examination

👥 Preparation & Positioning:
- Sit patient at eye level in good light.
- Ask them to fixate on your nose (do not look at your fingers).
- Explain: “Tell me as soon as you see my finger coming into view.”
👁️ Testing Each Eye (Confrontation):
- Ask patient to cover one eye with hand/occluder.
- You close your opposite eye (to mirror them).
- Bring a finger/pen from periphery → centre in 4 quadrants.
- Ask patient to say “now” when they first see it.
- Note any areas missed → possible visual field defect.
🔄 Repeat on the Other Eye:
- Switch occlusion and repeat exactly.
- Compare fields between both eyes.
🧐 Additional Observations:
- Check response consistency and reaction time.
- If available, confirm with automated perimetry for precision.

🗒️ Documentation & Communication

Record method used (confrontation test) and findings (e.g., “Right superior quadrantanopia”).
Explain results sensitively to the patient.
Recommend formal perimetry if defect detected.

⭐ Key OSCE Points

Systematic: Preparation → Test Each Eye → Compare → Document.
Clear communication keeps patient comfortable.
Check fixation carefully → ensures accuracy.
Always compare both eyes → asymmetry is key.

🚫 Common Pitfalls

Not explaining → confused patient, poor cooperation.
Poor fixation → unreliable results.
Skipping quadrants → missed defects.
Not comparing both eyes.

📚 References & Further Reading

Geeky Medics: Visual Field OSCE Guide
Clinical Methods – Walker et al.
OSCEstop – Practice stations and notes.

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OSCE Examination of Visual Fields

👋 Introduction