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Investigations > Posterior segment examination > Flashcards

Posterior segment examination Flashcards

1
Q

What are 12 parts of the posterior segment examination?

A
  1. Test for RAPD pre-dilation
  2. Observe habitus, face, orbits
  3. Examine iris
  4. Examine lens
  5. Examine vitreous
  6. Examine disc
  7. Examine disc margin
  8. Examine disc vessels
  9. Examine peripapillary area
  10. Examine macula
  11. Examine retinal vessels
  12. Examine peripheral fundus
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2
Q

What are 2 types of illumination that can be used to examine the vitreous?

A
  1. Conventional illumination
  2. Red-free illumination
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3
Q

What are 2 types of illumination that can be used to examine the peripapillary area?

A
  • conventional illumination
  • red-free illumination
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4
Q

What are 3 techniques for examining the posterior segment?

A
  1. Slit lamp
  2. Indirect ophthalmoloscopy
  3. Diret ophthalmoscopy
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5
Q

What is used in combination with the slit lamp to investigate the posterior segment?

A

handheld lens e.g. 90D or equivalent

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6
Q

What are 2 things that must be balanced with the choice of hand held lens with the slit lamp for posterior segment examination?

A
  1. greater magnification e.g. 66D lens
  2. vs. wider field of view e.g. 90D lens
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7
Q

What are 2 examples of handheld lens that attempt to combine the properties of magnificant and field of view for posterior segment examination?

A
  1. SuperField
  2. Super 66
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8
Q

What type of lens with the slit lamp provides highest clarify for posterior segment examination?

A

contact lens

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9
Q

What are 2 situaions when the clarify provided by CL + slit lamp is useful?

A
  1. assessing detail e.g. area centralis for macular pathology
  2. where view is poor e.g. media opacities
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10
Q

What is the retinal view using slit lamp + handheld lens?

A

inverted + reversed

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11
Q

What is another name for the Goldmann handheld lens?

A

three-mirror CL

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12
Q

What is the function of the three mirror CL + Goldmann lens?

A

facilitates examination of the periphery

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13
Q

What is the view with three-mirror contact lens (Goldmann) + slit lamp?

A

mirror-image rather than inverted

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14
Q

What is the method for examining the fundus with slit lamp + CL?

A
  • patient dilated (ideally)
  • slit-lamp adjusted so coaxial and focused on centre of cornea
  • lens interposed 1cm in front of eye and slit lamp drawn back until clear fundal view obtained
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15
Q

How can a CL + slit lamp be used to view the peripheral retina?

A

ask patient to look in the direction of the area you wish to examine (i.e. down to view the inferior retina)

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16
Q

How can troublesome reflections be reduced when performing posterior segment examination with slit lamp + CL?

A

by moving the illumination beam slightly off-axis

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17
Q

What is the instrument of choice for examining the fundus?

A

indirect ophthalmoscopy

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18
Q

What is indirect ophthalmoscopy assisted by?

A

scleral indentation

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19
Q

What are 2 things that the choice of lens for indirect ophthalmoscopy depends on?

A
  1. need for greater magnification e.g. 3x with 20D lens but smaller field of view
  2. vs wider field of view e.g. larger field of view with 28D lens, but only 2x magnification
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20
Q

What is the image of the retinal view in indirect ophthalmoscopy?

A

inverted and reversed

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21
Q

What is the method for performing posterior segment examination with indirect ophthalmoscopy?

A
  • pt must be well dilaed, positioned flat and looking up at ceiling
  • lens, indenter and retinal chart / paper must be available
  • align eyepieces and illuminatino by viewing your own oustretched thumb
  • ensure headband sufficiently tight so ophthalmoscope remains secure
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22
Q

What causes you to adjust illumination brightness when performing indirect ophthalmoscopy?

A

according to quality of view and patient comfort

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23
Q

At what angle should you perform indirect ophthalmoscopy?

A

view from above, scope directed down towards pupil, lens held in line of illumination
to view peripheral retina ask patient to look in direction of area to be examined whils angling head and lens in the opposite direction

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24
Q

How is scleral indentation performed with the indirect ophthalmoscope?

A

to view e.g. the inferior ora serrata, ask pt to look straight up and plae the indenter on the outside of the lowerw lid, resting tangentially against the area to be indented
then ask pt to look straight down, moving the indenter with the globe
observe area of interest whilst gently exerting pressure over it

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25
Q

What should you warn the patient about when using the scleral indenter?

A

may be uncomfortable

26
Q

What is the magnification of the direct ophthalmoscope?

A

15x (high)

27
Q

Is the retinal view inverted with direct ophthalmoscopy?

A

no (virtual, erect)

28
Q

How can the field of view be maximised with direct ophthalmoscopy?

A

coming as close as possible to the eye

29
Q

From what angle should you approach direct ophthalmoscopy?

A

temporally 15-20 degrees, on same horizontal level as patient

30
Q

How is the Amsler grid used?

A

ask patient to fix one eye at a time on the central dot and comment on whether any of hte small squares are missing or distorted

31
Q

At what distance is the Amsler grid viewed?

A

1/3m

32
Q

How many Amsler charts are there and which is suitable for most patients?

A

7 charts; chart 1

33
Q

What does the Amsler chart 1 consist of?

A

20 x 20 grid of 5mm squares, each representing 1 degree of central field (if viewed at 1/3m)

34
Q

What is the design, colour and use of Amsler chart 1?

A

standard grid; white on black; most patients

35
Q

What is the design, colour and use of Amsler chart 2?

A

standard grid with diagonals; white on black; helps fixation

36
Q

What is the design, colour and use of Amsler chart 3?

A

standard grid; red on black; tests colour scotoma e.g. optic neuropathy

37
Q

What is the design, colour and use of Amsler chart 4?

A

random dots, white on black, tests scotoma only (no lines to become distorted)

38
Q

What is the design, colour and use of Amsler chart 5?

A

horizontal lines, white on black, tests in one meridian (standard horizontal lines)

39
Q

What is the design, colour and use of Amsler chart 6?

A

horizontal lines, black on white, tests in one meridian (standard/fine horizontal lines)

40
Q

What is the design, colour and use of Amsler chart 7?

A

standard/ fine central grid, white on black, high sensitivity for central lesions

41
Q

How is the Watzke-Allen test performed?

A

whilst using slit lamp and handheld lens to view the macula, strip of light is projected across the fovea; pt asked whether line is broken, narrowed or complete

42
Q

What does a clear gap in the viewed strip of light with the Watzke-Allen gap test indicate?

A

Watzke-Allen positive - full-thickness macular defect/hole

43
Q

What are the 4 parts of the Goldmann three-mirror lens used with the slit lamp for central and peripheral fundus examination?

A
  1. Central (view central 30 degrees)
  2. Equatorial mirror (largest, views 30 degrees to equator)
  3. Peripheral mirror (intermediate, views equator to ora)
  4. Gonioscopic mirror (smallest, views ora, pars plana and angle)
44
Q

What part of the retina is viewed by the central part of the Goldmann three-mirror lens?

A

view central 30 degrees

45
Q

What is the largest part of the three mirror Goldmann lens?

A

equatorial mirror

46
Q

What is the smallest part of the three mirror Goldmann lens?

A

gonioscopic mirror

47
Q

What part of the fundus does the equatorial mirror of the Goldmann three mirror lens view?

A

30 degrees to the equator

48
Q

What part of the fundus does the peripheral mirror of the Goldmann three mirror lens view?

A

views equator to ora

49
Q

What 3 things does the gonioscopic mirror of the three mirror Goldmann lens view?

A

ora, pars plana, angle

50
Q

What is a version of standardised representation of vitreo-retinal pathology?

A

retinal charts

51
Q

What are retinal charts being replaced by?

A

ultrawide-field imaging techniques e.g. Optos

52
Q

How is a detached retina represented on a retinal chart?

A

blue

53
Q

How is a flat retina represented on a retinal chart?

A

red

54
Q

How are retinal veins represented on a retinal chart?

A

blue

55
Q

How are retinal breaks represented on a retinal chart?

A

red within a blue outline

56
Q

How is retinal thinning represented on a retinal chart?

A

red hatching within a blue outline

57
Q

How is lattice degeneration represented on a retinal chart?

A

blue hatching within a blue outline

58
Q

How is pigment represented on a retinal chart?

A

black

59
Q

How is exudate represented on a retinal chart?

A

yellow

60
Q

How are vitreous opacities represented on a retinal chart?

A

green

Investigations (29 decks)

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