Otoscopy & Ophthalmoscopy Flashcards
Indications of otoscopy
- earache
- hearing loss
- ear discharge
- tinnitus
- dizziness
- viral symptoms
- head injury (basal skull fracture)
Key anatomy of the ear
- pinna
- helix
- tragus
- preauricular area
- postauricular area
(Bony prominence = mastoid process of temporal bone)
Anatomy of tympanic membrane (eardrum)
4 quadrants: Antero/postero-sup/inf
Malleus (ossicle) should always be visible
Incus may be visible posterior to malleus
Otoscopy step 1
Preparation
- PPE, wash hands, introduce self, explain procedure
- check pt details, gain consent, ask about pain
- ask to remove foreign bodies (hearing aids, large piercings)
Otoscopy step 2
Inspection
- symmetry, position
- piercing, hearing aids
- pre-auricular, pinna, EAM, mastoid
- deformity, erythema, swelling, scars, discharge, skin lesions
Otoscopy step 3
Palpation
- tragus (press)
- tug pinna gently
- press on mastoid
Check for tenderness
Otoscopy step 4
Procedure
- apply speculum to otoscope , turn on light
- right hand right ear (vv)
- start with better ear
- pull pinna up and back with other hand (straighten EA canal) — down and back in children
Otoscopy proper
- insert speculum tip to EAM
- rest ulnar border of hand against pt cheek
- slowly advance speculum
- inspect canal for wax, foreign bodies, erythema, oedema, discharge
- inspect tympanic membrane,noting colour, shape, structure, light reflex
(Withdraw & repeat in other ear, discard speculum)
Types of ophthalmoscope
Direct - upright image, not inverted, greater magnification (traditional)
Indirect - reversed and inverted image (slit lamp)
Key features of an ophthalmoscope (practitioner’s side)
- rheostat (adjusts light beam intensity)
- dioptre dial (alters lens)
- dioptre power display (green close, red far)
- eye window
Key features of an ophthalmoscope (patient’s side)
- aperture dial (alters light beam size)
- filter switch (selection of light filter)
When to choose different size light beams in ophthalmoscopy?
Large - dilated pupil
Medium - dark room, non-dilated
Small - constricted pupil
What do each of the 4 filters of an ophthalmoscope do?
- Red free - retina b&w, contrast allows visualisation of vessels
- Slit beam - detect abnormalities in cornea, retina & lens
- Blue light - ID corneal abrasions (fluorescein eye drops staining)
- Grid - approx distance btw retinal lesions
What are the features of the anterior segment of the eye?
Anterior 1/3
- iris
- conjunctiva
- cornea
- pupil
- lens
What are the eateries of the posterior segment of the eye?
Posterior 2/3
- vitreous humour
- retina
What is the retina?
The neurosensory layer at the back of the eye that absorbs light energy & converts it to electrical impulses.
What is the red reflex of the eye?
Reflection of reddish-orange light from retina
What are the four quadrants of the retina?
ST - superior temporal
IT - inferior temporal
SN - superior nasal
IN - inferior nasal
What are the arcades of the central retinal artery & vein in the ST quadrant?
Superior temporal retinal arteriolar & venule (etc.)
Name the key features of the retina
- optic disc (yellow)
- optic cup (white)
- macula lutea (centre, area of highest visual acuity)
- fovea centralis (centre of macula)
What
Ophthalmoscopy step 1
- WIPE
- consent & check pain
(Explain:
- eyelids, front & back of eye
- close to face
- no driving for several hours after dilating eye drops (blurry vision, sensitivity to light))
Ophthalmoscopy step 2
General Inspection (external eyes)
- eyelids (swelling, drooping, stye)
- eyelashes (loss)
- cornea (abrasions, ulcers)
- conjunctiva (discharge, diffuse conjunctival injection/redness)
- iris (shape, colour)
- pupil (shape, size, symmetry)
Ophthalmoscopy step 3
(Dark room, seated, fixed ahead, eye drops)
Dioptre - 0 (normal visual acuity)
Assess Red Reflex
Shine light into pt eye at arm’s length (observe reddish reflecton)
Ophthalmoscopy Step 4
Close inspection (ant) = GREEN numbers
- same hand same eye
- free hand on forehead/shoulder
- inspect ant segment
Ophthalmoscopy Step 5
Examine fundus
(Add your refractive error to pts refractive error and adjust dioptre)
- 45 deg, move closer, maintain red reflex
1. Blood vessels
2. Optic disc
Contours (borders)
Colour (orange-pink = healthy & well-perfused)
Cup (colour, relative vertical size = 0.3)
- Quadrants (clockwise)
Ophthalmoscopy Step 6
Assess Macula
- look into light
- fovea dark
Ophthalmoscopy Step 7 (finish)
- examine other eye
- thank, finish, summarise
Suggest further tests:
- CN exam
