Fundoscopy Flashcards
what should you do before starting the fundoscopy
hand hygiene
introduce yourself
dim the lights
ask patient to remove their glasses and remove your own glasses unless you have a high prescription
use short acting mydriatic drops to dilate the pupils eg. tropic amide 0.5 or 1%
what should you do prior to pupil dilation
examine pupil reflexes and visual acuity and visual field because you won’t be able to do this once their pupils are dilated
where should the patient look and where should you stand
give the patient a target in the distance straight ahead of them
stay out of the patients line of sight (by standing about 15° to the side) to keep their eyes still and prevent pupil constriction which is caused by the accomodation reflex
to examine the patient’s right eye
use your right eye with the ophthalmoscopy in your right hand
line up their right with your right and vice versa
stand/sit at arms length
prior to fundoscopy you should examine
red reflex and examine the anterior segment (front part) of the eye
red reflex looks like
assessed at arms length by aiming the light beam into each pupil and observing the reflected glow which would be symmetrical orange/red colour
if the red reflex is absent or dull
this indicates an opacity somewhere in the ocular media (cornea, anterior chamber, lens or vitreous)
absent or dull red reflex in a newborn baby or infant
requires urgent referral to ophthalmology
may be due to a rare but serious intraoccqular tumour called retinoblastoma
tp examine the anterior segment
place the offhand on the patients forehead for stability
sit at 15° to the patient
examine the eye for conjunctival injection or corneal opacities
you’ll need to dial the lens to 10 for a clear view here
what does fundoscopy look like and what are the features you see on fundoscopy
how do you tell a vein from an artery
they’re wider and darker
vascular tortuosity looks like
this is seen in systemic hypertension
AV nicking looks like
this is seen in systemic hypertension
venous beading looks like
seen in severe diabetic retinopathy
two indicators of systemic hypertension seen on fundoscopy
AV nicking and tortuousity
perivascular abnormalities seen on fundoscopy include
cotton wool spots
retinal haemorrhages
retinal haemorrhage looks like
cotton wool spots looks like
you might see cotton wool spots in someone with
diabetic retinopathy
you may see retinal haemorrhages in someone with
central retinal vein occlusion
infratemporal quadrant
intranasal quadrant
supra nasal quadrant
supratemproal quadrant
where is the optic nerve located
in the nasal aspect of the fundus
remember nerve is
nasal
the three C’s of the optic disc
- colour
- cup
- contour
the colour of the optic disc
normal colour is yellow
becomes pale is cases of ischaemic optic neuropathy or giant cell arteritis
or reddish in a hyperaemic optic disc from optic disc swelling
contour of the optic disc
(margins/circumference of the disc)
should be well defined
if the contour is blurred this may be due to optic disc swelling
if optic disc swelling is present in both eyes this is
this is papilloedema
papilloedema is from
raised intracranial pressure or malignant hypertension
requires urgent attention
causes of raised intracranial pressure that may cause papilloedema
intracranial tumour
idiopathic intracrhail hypertension
cerebral abscess
hydrocephalus
central pale portion of the optic disc is called the
optic cup
normal ratio of diameter between the optic cup and the optic. disc is
average cup to disc ratio is .3 to 0.5
if the ratio above normal or there is a lot of asymmetry between the two discs this may indicate
possible glaucoma
optic disc neovascularisation
fne frilly vessels seen in patients with diabetes
how do you find the macula
temporal to the optic disc
or ask the patient to look directly into the light which should automatically should you their retina
normal macula looks
dark orange or reddish
drusen
seen in age related macula degeneration
seen over the macula
hard exudate looks like
seen in diabetic retinopathy
in patients with sudden painless loss of vision you should look for
a pale whiteish macula with a cherry red centre (“cherry red spot”)
this indicates central retinal artery occlusion
how do you examine the retinal periphery
ask the patient to look up, down, left and right
what abnormalities should you look for on the retinal periphery
pigmented ocular tumour
retinal detachment
pigmented ocular tumour might look like
normal fudus consists of
green filter
also known as the red free filter
good for highlighting red structures
such as outline of blood vessels or micro aneurysms also known as dot haemorrhages
what do dot haemorrhages look like under green filter
papilloedema should be assumed to be
papilloadema should be assumed to be raised intracranial pressure due to a space occupying lesion in the brain until proven otherwise
