Conjunctival injection. The condition of the conjunctival tissue is evaluated on the basis of the extent of capillary engorgement and scleral jaundice. Examination is best conducted in clear daylight by asking the patient to direct his gaze upward and then downward while pulling back the upper and lower eye-lids. Under normal conditions, the normal pearly whiteness is widely distributed. In contrast, capillary engorgement is reflected in the appearance of burgundy-coloured vascular elements and the appearance of a greenish-yellow tinge to the sclera.
 
Abnormal skin vascularization. This is best evaluated by examination of the face and neck. These areas often give evidence of fine wiry arterioles that appear as a reddish blush. Other signs of chronic alcohol ingestion include the appearance of 'goose-flesh" on the neck and yellowish blotches on the skin.
 
Hand tremor. This should be estimated with the arms extended anteriorly, half bent at the elbows, with the hands rotated toward the midline.
 
Tongue tremor. This should be evaluated with the tongue protruding a short distance beyond the lips, but not too excessively.
 
Hepatomegaly. Hepatic changes should be evaluated both in terms of volume and consistency. Increased volume can be gaged in terms of finger breadths below the costal margin. Consistency can be rated as normal, firm, hard, or very hard.
 
Several laboratory tests are useful in the detection of alcohol misuse. Serum gamma-glutamyl transferase (GGT), carbohydrate deficient transferrin (CDT), mean corpuscular volume (MCV) of red blood cells and serum aspartate amino transferase (AST) are likely to provide, at relatively low cost, a possible indication of recent excessive alcohol consumption. It should be noted that false positives can occur when the individual uses drugs (such as barbiturates) that induce GGT, or has hand tremor because of nervousness, neurological disorder, or nicotine dependence.