Fundoscopy things before the exam Flashcards
What are you inspecting for when you look it the eyes
- Periorbital - swelling and oedema (preseptal/orbital cellulitis)
- Eyelids - Ptosis (Horner’s Syndrome, oculomotor palsy), Crusting/inflamed (blepharitis)
- Eyelashes - loss (malignancy), trichiasis
What does a diffuse conjunctival injection mean
- Means that there are dilated inflamed blood vessels across the majority of the conjunctia
- shows that there is bacterial, viral, or allergic conjcutivitis
What does a circumcillary injection mean
- Means that there is a dilated inflamed blood vessels in a circular pattern around the corner suggestive itnraocular inflammation
- this shows Keratitis, acute angle-closure, glaucoma, uveitis
What is discharge indicated on
- Watery (allergic/viral conductivity, corneal/abrasion/foreign body)
- Purulent (bacterial conjunctivitis)
What is hyphema
- Inferior settled layer of blood in the anterior chamber (trauma)
What is hypopyon
- Inferior settled layer of pus in the anterior chamber (anterior uveitis, corneal ulcers, endophthalmitis)
What are you looking for in the pupil
- Size, shape and symmetry
What does miosis mean
Pupillary constriction
What does mydriasis mean
Pupillary dilatation
What does anisocoria mean
- Asymmetry in pupil size between pupils
How do you prepare the fundoscopy
o State that you would want to make sure the room is darkened and to use mydriatic eye drops
(tropicamide 1%)
o Ask patient to look straight ahead for the duration of the examination
o Ensure the diopter dial is set to 0 (if you have normal visual acuity) or match it to your
prescription
What does an absence red reflex mean in adults
- cataracts
- vitreous haemorrhage
- retinal detachment
What does an absence red reflex mean in children
- Congenital cataracts
- retinoblastoma
- retinal detachement
- vitreous haemorrhage
What are you assessing in the fundus
Optic disc – begin by identifying a blood vessel and follow it back to the optic disc - Contour – blurred; papilloedema - Colour – pale; optic atrophy (optic neuritis, advanced glaucoma, ischaemic vascular events) - Cup – cup-to-disc ratio (0.3 normal); increased ratio suggests glaucoma
What does an increased cup to disc ratio suggest
- Glaucoma
- 0.3 is normal
How do you assess the macula using the fundoscope
- Ask the patient to look directly into the light and repeat for the other eye
What is the plan that you would use in fundoscopy
Summarise findings and differentials and formulate a plan, e.g. cranial nerve exam, full neurological exams of the upper and lower limbs, neuroimaging (CT/MRI head), referral to ophthalmology
How does aperture change with pupil size
- Use a small aperture with a small lit room
- Medium = Standard for a non-dilated pupil in a dark room
- Large = dilated pupil after administrating mydriatic drops
What do you use a cobalt blue filter for
- to look for abrasions or ulcers with fluorescin dye
What do you use a red-free filter for
- DONT CALL IT GREEN (LOOKS GREEN ON FUNDOSCOPE)
- enhances the appearance of blood vessels and haemorrhages by making blood show up black
if the patient is wearing glasses should you ask them to remove them
yes - they should remove there glasses
What does the red reflex mean
A reflection of light off the retinal and back through the aperture of the ophthalmoscope
What is papilloedmea
- this is the swelling of the optic nerve as it enter the back of the eye due to raised intracranial pressure e
What are the symptoms related to papilloedmea caused by ICP include:
- nausea
- vomiting
- headache
- brief visual blackouts triggered by change in position
- tinnitus
- flashing lights
What are the causes of raised intra cranial pressure
- Increase in brain volume - e.g. SOL, Abscess
- Increase in CSF volume - e.g. Hydrocephalus
- increase in blood volume (e.g. cerebral venous thrombosis, meningitis)
