Fundoscopy Flashcards
What are the steps?
Introduction, Identification, Explanation and Consent
Preparation
Examination - red reflex, fundoscopy, fundus
Preparation
- Patients pupils should, ideally be dilated either by:
- Examining in a dark room
- Instilling drops to dilate pupils (postgrad only) - Ensure you and the patient are in a comfortable position
- Patient to fix haze on a small named distant object
- Use your right eye and right hand to examine patient’s right eye, and your left eye and left hand for patients left eye
Red Reflex
Switch on and select lens ‘0’, hold ophthalmoscope vertically in your hand, brow-piece touching your eyebrow
Direct beam of light into pupil from a distance of approx 30cms
Presence of the red reflex demonstrates that light is entering the eye and being reflected back from the fundus; absence indicates obstruction to light pathway e.g. cataract
The red eye reflex can be done for both eyes at this stage, before moving onto fundoscopy
Fundoscopy
To examine patient’s right eye
- Sit/stand a little to the right of the patient (approx 15 degrees from midline), allowing patient a clear view of a distant named object over your right shoulder
- Ask the patient to try to keep looking at the object, in order to keep the eyes still
- Hold ophthalmoscope vertically in your right hand, brow-piece touching your eyebrow, right index finger placed, semi-flexed, on lens dial
- Select “0” on lens dial
Fundoscopy
To examine patient’s left eye
- Same as right eye, but sitting/standing a little to the left of the patient, using your left eye and left hand to view the fundus
- hold scope vertically in your left hand, brow-piece touching your eyebrow, left index finger placed, semi-flexed, on lens dial
- Select “0” on lens dial
Examine Fundus
Focussing on the Fundus
Move nearer the patient so that the ophthalmoscope is at a distance of approx 2-4cms from the patient’s eye - This will usually be when the knuckles of the hand holding the ophthalmoscope touch the patient’s cheek
Ensure your eye and patient’s eye are on the same horizontal level
Always hold the ophthalmoscope with your index finger semi-flexed on t the lens dial to make lens adjustment easier
Adjust lenses to obtain a sharp image of the fundus - Starting with lens ‘0’ focus on the disc or a blood vessel, if blurred increase or decrease
Examine Fundus
What are you commenting on for the fundus?
Optic disc
Vessels
Retina
Macula
What do you comment on for the optic disc?
- Shape
- Colour
- Definition of edges
- Note appearance of vessels as they cross rim
What do you comment on for the vessels?
Note appearance of arteries, veins - tortuous, congested, arteriovenous nipping
What do you comment on for the Retina?
- Colour
- Haemorrhages
- Exudates
- Detachment
- Tears
Macula
Ask patient to look directly at the beam of light just before finishing looking at that eye