Fundoscopy things before the exam

Question 1

What are you inspecting for when you look it the eyes

Answer 1

• Periorbital - swelling and oedema (preseptal/orbital cellulitis)
• Eyelids - Ptosis (Horner’s Syndrome, oculomotor palsy), Crusting/inflamed (blepharitis)
• Eyelashes - loss (malignancy), trichiasis

Question 2

What does a diffuse conjunctival injection mean

Answer 2

• Means that there are dilated inflamed blood vessels across the majority of the conjunctia
• shows that there is bacterial, viral, or allergic conjcutivitis

Question 3

What does a circumcillary injection mean

Answer 3

• 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

Question 4

What is discharge indicated on

Answer 4

• Watery (allergic/viral conductivity, corneal/abrasion/foreign body)
• Purulent (bacterial conjunctivitis)

Question 5

What is hyphema

Answer 5

• Inferior settled layer of blood in the anterior chamber (trauma)

Question 6

What is hypopyon

Answer 6

• Inferior settled layer of pus in the anterior chamber (anterior uveitis, corneal ulcers, endophthalmitis)

Question 7

What are you looking for in the pupil

Answer 7

• Size, shape and symmetry

Question 8

What does miosis mean

Answer 8

Pupillary constriction

Question 9

What does mydriasis mean

Answer 9

Pupillary dilatation

Question 10

What does anisocoria mean

Answer 10

• Asymmetry in pupil size between pupils

Question 11

How do you prepare the fundoscopy

Answer 11

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

Question 12

What does an absence red reflex mean in adults

Answer 12

• cataracts
• vitreous haemorrhage
• retinal detachment

Question 13

What does an absence red reflex mean in children

Answer 13

• Congenital cataracts
• retinoblastoma
• retinal detachement
• vitreous haemorrhage

Question 14

What are you assessing in the fundus

Answer 14

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

Question 15

What does an increased cup to disc ratio suggest

Answer 15

• Glaucoma

- 0.3 is normal

Question 16

How do you assess the macula using the fundoscope

Answer 16

• Ask the patient to look directly into the light and repeat for the other eye

Question 17

What is the plan that you would use in fundoscopy

Answer 17

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

Question 18

How does aperture change with pupil size

Answer 18

• 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

Question 19

What do you use a cobalt blue filter for

Answer 19

• to look for abrasions or ulcers with fluorescin dye

Question 20

What do you use a red-free filter for

Answer 20

• DONT CALL IT GREEN (LOOKS GREEN ON FUNDOSCOPE)

- enhances the appearance of blood vessels and haemorrhages by making blood show up black

Question 21

if the patient is wearing glasses should you ask them to remove them

Answer 21

yes - they should remove there glasses

Question 22

What does the red reflex mean

Answer 22

A reflection of light off the retinal and back through the aperture of the ophthalmoscope

Question 23

What is papilloedmea

Answer 23

• this is the swelling of the optic nerve as it enter the back of the eye due to raised intracranial pressure e

Question 24

What are the symptoms related to papilloedmea caused by ICP include:

Answer 24

• nausea
• vomiting
• headache
• brief visual blackouts triggered by change in position
• tinnitus
• flashing lights

Question 25

What are the causes of raised intra cranial pressure

Answer 25

1. Increase in brain volume - e.g. SOL, Abscess
2. Increase in CSF volume - e.g. Hydrocephalus
3. increase in blood volume (e.g. cerebral venous thrombosis, meningitis)