Basics of Funduscopy
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Transcript of Basics of Funduscopy
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Basics of Optic fundus Exam
Norwin A. Detalla, MD
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Objectives
Describe Patient preparation Demonstrate correct procedure using
the ophthalmoscope Describe the normal fundus Describe abnormal findings, and
recognize disease process
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Direct Ophthalmoscope
Viewing aperture
Beam Selector
Rheostat
Handle
Brow Rest
Peephole
Lens wheel
Lens power
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Optic disc
Optic cup
Vein
Arterioles
Fovea
Normal Ocular Fundus
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Normal fundus
Disc: Clear outline; optic cup is pale and centrally located.
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Normal fundus
Disc: Clear outline; optic cup is pale and centrally located.
Retina: Normal red/orange colour, macula is dark. The macula is approximately 2 disc diameters away from disc and 1.5 degrees below horizon.
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Normal fundus
Disc: Clear outline; optic cup is pale and centrally located.
Retina: Normal red/orange colour, macula is dark. The macula is approximately 2 disc diameters away from disc and 1.5 degrees below horizon.
Vessels: Arterial/venous ratio 2 to 3; the arteries appear a bright red, the veins a slightly purplish colour.
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Optic nerve
Consists of 1 million axons that arise from the retina.
Leaves the eye through the sclera – optic canal – into the cranium.
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What to observe
Optic disc- colour/size/edges Cup – size Blood vessels –
number/width/tortuosity Macular / fovea Other findings –hemorrhages, soft
and hard exudates, edema
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Procedure
Ask patient to fix stare at far object Turn on scope and set dial to 0 Remember right eye right hand Rest hand on patients forehead Begin at arms length away, should see red
reflex. Move closer until optic disc visible ( approx. 3-
5cms) Turn dial until disc in focus. Hyperopic – turn disc for plus numbers (green) Myopic – minus numbers (red)
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Micro Spot Aperture: Allows quick visual entry in very small, undilated pupil
Small Aperture: Provides easier view of fundus through undilated pupil
Large Aperture: Standard aperture for dilated pupil and general examination of the eye
Fixation Aperture: Features graduated cross-hairs for measuring eccentric fixation or for locating lesions and other abnormalities
Slit: Used to determine various levels of lesions and tumors
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Cobalt Filter: Blue filter used with Fluorescein dye permits easy viewing of small lesions, abrasions and foreign objects on the corneal surface
Red Free Filter: Green filter used to study blood vessels and retinal nerve fiber layer (RNFL)
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Microaneurysm / dot blot hemorrhage
Flame-shaped hemorrhage
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Exudates
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Macular edema
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Cotton-wool spot
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Vitreous hemorrhage
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Neovascularization
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Hypertensive Retinopathy
Modified Scheie Classification Grade 0: No changes Grade 1: Minimal arteriolar narrowing Grade 2: Obvious arteriolar narrowing
with focal irregularities Grade 3: Grade 2 + retinal hemorrhages
and/or exudate Grade 4: Grade 3 + swollen optic nerve
(Malignant hypertension)
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Hypertensive RetinopathyGrade 2
Arteriovenous nicking in association with hypertension Grade 2
(black arrows)
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Hypertensive RetinopathyGrade 3 Flame-shaped
hemorrhage in association with severe hypertension Grade 3 (red arrow)
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Hypertensive RetinopathyGrade 4 Papilledema from
malignant hypertension. There is blurring of the borders of the optic disk with hemorrhages (red arrows) and exudates (white arrow)
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