AVPS - Opthalmoscopy I - Topic 4 Flashcards
Why do we assess ocular health?
- Legal Requirement – Opticians Act (1989), section 4
- To identify ocular health problems
- There are no contraindications
- Arguably the most important part of the eye examination
How would you record the result from checking the red reflex?
Record as ‘normal/symmetrical red reflex in both eyes’, ‘red reflex present R&L’ if normal, or otherwise as appropriate.
For checking the anterior eye, what is the systematic approach?
- Red Reflex (Step 3)
- Adnexa/Eyelids and Eyelashes
- Conjunctiva/Sclera
- Cornea/Limbus
- Iris
- Pupil/Lens
Whats the adnexa for eyes?
the orbit, conjunctiva, and eyelids (area around the eyes)
How do you record results after checking adnexa/eyelids/eyelashes?
Be descriptive.
E.g “smooth lids, no ptosis/proptosis, no lumps/bumps, even colour, no redness/swelling, no deposits in eyelashes and all present”.
NB: Don’t be afraid to draw!
What’s ptosis?
Droopy Eyelid
What’s proptosis?
Eyes are bulging forward
When checkingConjuctiva/Sclera, how would you record your results?
conjunctiva white and smooth in all positions, no redness, no roughness, no swelling”.
NB: Lift up the upper eyelid with your other hand when the patient is looking down so you can see
When checking the Cornea/Limbus, how would you record your results?
E.g “cornea clear/transparent, no foreign bodies, no vascularization”.
NB: The cornea is supposed to be transparent so a ‘normal’ cornea will have nothing much to see!
When checking the Iris, how would you record your results?
“brown iris, evenly pigmented, no raised areas/vascularization”.
When checking the Pupil/lens, how would you record your results?
“round pupil, 4mm diameter in habitual light, even pupillary ruff”.
For the lens, remember it is supposed to be transparent – so if it is normal you won’t see very much!
Look for changes in colour (esp white/yellow)/lack of transparency.
It is actually easiest to look at the lens using retro-illumination
Limitations (for anterior eye assessment) using Opthalmoscope?
- Low magnification.
- Monocular technique so no stereopsis (3D vision).
- Minimal lighting variability.
What are we looking for when checking for red reflex?
We are looking for a universal red/orange glow – we don’t want to see no reflex, or leukocoria (white reflex).
What are we looking for when checking for health of Adnexa/Eyelids/Eyelashes?
Look for changes in colour (red/brown), lumps, bumps, rough areas, ulceration, loss of/irregular eyelashes, greasy deposits/flakes in eyelashes.
What are we looking for when checking health of conjuctiva?
Look for changes in colour (esp redness), raised/swollen/rough areas, irregular vessels
What are we looking for when checking health of Cornea/Limbus?
Look for loss of transparency, foreign bodies, ulceration, small blood vessels at the edge
What are we looking for when checking health of iris?
Look for differences in colour/texture, any raised areas, blood vessels (especially at the pupil margin), transillumination
What are we looking for when checking health of Pupil/Lens?
- For the pupil, look for shape, size and the margin
- For the lens, remember it is supposed to be transparent – so if it is normal you won’t see very much!
Why do we record the right eye on the left side of the page?
From the perspective of the practioner, the right eye is on our left side
Why do we need to be at +10D at 10cm to be in focus? Why not -10D?
1/0.1= 10, The lens power cancel’s out at 10cm. but wouldn’t at -10D.
Why do you think ophthalmoscopy is not considered the best technique (the ‘gold standard’) for examining the anterior eye? If this is the case – why do you need to learn how to do it?
- Low magnification and limited lighting variabilty, not useful for examining anterior eye
- Useful if there is no slit lamp
If you/your patient wear glasses, what difference does it make taking them off for ophthalmoscopy?
- The opthalmoscope will adjust to your prescription, so no need to wear spectacles
