AVPS - Opthalmoscopy I - Topic 4

Question 1

Why do we assess ocular health?

Answer 1

• 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

Question 2

How would you record the result from checking the red reflex?

Answer 2

Record as ‘normal/symmetrical red reflex in both eyes’, ‘red reflex present R&L’ if normal, or otherwise as appropriate.

Question 3

For checking the anterior eye, what is the systematic approach?

Answer 3

1. Red Reflex (Step 3)
2. Adnexa/Eyelids and Eyelashes
3. Conjunctiva/Sclera
4. Cornea/Limbus
5. Iris
6. Pupil/Lens

Question 4

Whats the adnexa for eyes?

Answer 4

the orbit, conjunctiva, and eyelids (area around the eyes)

Question 5

How do you record results after checking adnexa/eyelids/eyelashes?

Answer 5

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!

Question 6

What’s ptosis?

Answer 6

Droopy Eyelid

Question 7

What’s proptosis?

Answer 7

Eyes are bulging forward

Question 8

When checkingConjuctiva/Sclera, how would you record your results?

Answer 8

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

Question 9

When checking the Cornea/Limbus, how would you record your results?

Answer 9

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!

Question 10

When checking the Iris, how would you record your results?

Answer 10

“brown iris, evenly pigmented, no raised areas/vascularization”.

Question 11

When checking the Pupil/lens, how would you record your results?

Answer 11

“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

Question 12

Limitations (for anterior eye assessment) using Opthalmoscope?

Answer 12

• Low magnification.
• Monocular technique so no stereopsis (3D vision).
• Minimal lighting variability.

Question 13

What are we looking for when checking for red reflex?

Answer 13

We are looking for a universal red/orange glow – we don’t want to see no reflex, or leukocoria (white reflex).

Question 14

What are we looking for when checking for health of Adnexa/Eyelids/Eyelashes?

Answer 14

Look for changes in colour (red/brown), lumps, bumps, rough areas, ulceration, loss of/irregular eyelashes, greasy deposits/flakes in eyelashes.

Question 15

What are we looking for when checking health of conjuctiva?

Answer 15

Look for changes in colour (esp redness), raised/swollen/rough areas, irregular vessels

Question 16

What are we looking for when checking health of Cornea/Limbus?

Answer 16

Look for loss of transparency, foreign bodies, ulceration, small blood vessels at the edge

Question 17

What are we looking for when checking health of iris?

Answer 17

Look for differences in colour/texture, any raised areas, blood vessels (especially at the pupil margin), transillumination

Question 18

What are we looking for when checking health of Pupil/Lens?

Answer 18

• 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!

Question 19

Why do we record the right eye on the left side of the page?

Answer 19

From the perspective of the practioner, the right eye is on our left side

Question 20

Why do we need to be at +10D at 10cm to be in focus? Why not -10D?

Answer 20

1/0.1= 10, The lens power cancel’s out at 10cm. but wouldn’t at -10D.

Question 21

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?

Answer 21

• Low magnification and limited lighting variabilty, not useful for examining anterior eye
• Useful if there is no slit lamp

Question 22

If you/your patient wear glasses, what difference does it make taking them off for ophthalmoscopy?

Answer 22

• The opthalmoscope will adjust to your prescription, so no need to wear spectacles