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Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
Fundus examination
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Fundus examination

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A precise fundamental lesson on examination of fundus

A precise fundamental lesson on examination of fundus

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  • 1. RAJVIN SAMUEL PONRAJ
  • 2.
    • APPERANCE : Uniform red
    • Punctate stippling-periphery
    • Varies-color of individual
    • Normal choroidal vessels
    • - Invisible
    • PARTS : DISC
            • VESSELS
            • MACULA
            • PERIPHERY
  • 3.  
  • 4.
    • ORA SERRATA – Junction between
    • peripheral retina and pars
    • plana
    • CONTENTS - DENTATE PROCESSES
    • ORAL BAYS
    • NORMAL VARIANTS : Meridoneal fold
    • enclosed bay
    • microcystic degeneration
    • granulation tissue
  • 5.  
  • 6.  
  • 7. LAMINA CRIBROSA NEURORETINAL RIM
  • 8. DISC: LOCATION –nasal to geometric axis DIAMETER – 1.5mm [1 disc diameter] COLOR – Pale pink SHAPE – Circular EDGES – Regular TERMINATION OF ALL LAYERS EXCEPT NFL CUP: C/D ratio – 0.3 to 0.5
  • 9.
    • RETINAL SYSTEM :
    • CENTRAL RETINAL ARTERY
    • AND
    • CENTRAL RETINAL VEIN
    • 4 major branches
    • Arterioles
    • Venules
    • Capillaries
    • CILIARY SYSTEM : POST.CILIARY ARTERIES
    • Choriocapillaries
  • 10.  
  • 11.
    • Specialised region of retina
    • Diameter – 5.5 mm
    • Location – 2 DD - temporal margin of disc
    • Color – Yellow; deep pigmented
    • 4 zones : Foveola -0.35 mm
      • Fovea -1.50 m
      • Parafovea
      • Perifovea
    • Retinal vessels
    • Cilioretinal artery
  • 12.
    • Fovea - Thin bottom
    • thick basement margin
    • - prone for macular holes
    • -Henle’s layer-oblique cones
    • Foveola - Thin pit , Densely cones
    • Bowing vitreally- fovea externa
    • Umbo - Tiny depression - Foveal light reflex
    • bouquet of cones - narrowed
    • gateau nucleaire
  • 13.
    • Posterior pole – loss of foveal light reflex
    • drusen
    • Retinal vessels – narrowing, increased light reflex
    • Equator - chorio , reticular pigmentary degeneration
    • Vitreous - liquefaction , floaters ,..
  • 14.
    • Why it is performed:
    • It can detect some signs & physiological effects of various circulatory, metabolic and neurological disorders.
    • Routinely used to assess and diagnose vitro-retinal diseases (such as Diabetic retinopathy, retinal tear and detachment, macular hole, retinal haemorrhage, retinal artery and vein occlusion, choroidal tumor, or macular edema), optic nerve defects, and hereditary diseases.
  • 15.
    • Fundus examination is used to:
    • Identify and locate vitro-retinal and optical nerve defects caused by eye diseases or trauma.
    • Examine the extent of the defects or abnormalities to plan a proper treatment.
    • Evaluate the success of treatment .
  • 16.
    • Combination of phenylephrine [2.5 %] &
    • tropicamide [1 %]
    • then eyes closed
    • Dilation attained = 45 min
    • Normal reactivity = 4 - 8 hrs
    • Conditions which to avoid : iris supported lens
    • shallow AC
    • Head injury
  • 17.  
  • 18.
    • - retinal arterioles - exudate
    • retinal haemorrhage edema
    • microaneurysm
    • attached retina - vitreous opacity
    • hole /break vitreous bleed
    • - Retinal venules - pigmentation
    • detached retina detached choroid
    • outine of break
    • - ora serrata /drusen
    • hyperpigmentation
  • 19.
    • Vitreoretinal chart Optic Disc drawing
  • 20. METHODS OF EXAMINATION
    • DIRECT OPHTHALMOSCOPY
    • INDIRECT OPHTHALMOSCOPY
    • INDIRECT SLIT LAMP BIOMICROSCOPY
  • 21. D IRECT OPHTHALMOSCOPY
  • 22.
    • An erect upright virtual image
    • Magnification = 15 x
    • Field of view = 5 degrees
    • Optimal working distance upto 2-3 cms
    • No stereoscopic view
    • Several plus and minus dial up lenses
    • Structures - optic nerve, blood vessels of posterior pole
    • fovea
    • Viewing aperture contains illumination openings
    • 1. spots 4.fixation target
    • 2.streak projection 5. calibration grid
    • 3.Red free filter
  • 23.
    • Evaluating fundus :
  • 24.  
  • 25. Indirect ophthalmoscopy
  • 26.
    • An inverted reverse real image
    • Magnification = 2 to 4 X
    • Field of view = 40 to 50 degrees
    • Optimal working distance = 40 to 50 cms
    • Good illumination & stereopsis
    • Ease of use with scleral indentor
    • Lenses from 14 to 30 D range
    • Positioning of patient
  • 27.
    • Head set adjustment
    • Eye piece adjustment
    • Light beam adjustment
    • Choosing ,positioning and technique to hold condensing lens.
  • 28.  
  • 29.
    • 12 ‘0’ Clock meridian towards patient’ feet and transforming the image rotated 1 80 degrees .
    • Follow vessels and bifurcations in each quadrant then with scleral indentation terminal branches.
    • Ora serrata then fundal lesions with relations .
  • 30.
    • Field of view is proportional to power of lens but inverse of magnification
    • Hence wider field will have less magnification with higher powered lenses.
    • Higher power lenses used in small pupils, peripheral fundus view.
  • 31.  
  • 32.
    • -Thimble scleral
    • depressor
    • Pencil type depressor
    • Cotton tipped applicator
    To examine periphery between equator and ora serrata by creating a mound to view. Start superonasal superior ,superotemporal, Inferotemporal, inferior, inferonasal
  • 33.  
  • 34.  
  • 35.
    • An inverse real reversed image with hand held lenses
    • Field of view = 30 to 40 degrees
    • Lens power = + 78 or + 90 D , other lenses= + 60 to 132 D
    • Magnifying knob to 10 X or 16 X
    • Drawing the slit lamp biomicroscopic view:
    • Done on an inverted fundus chart and paper is turned as patients gaze direction changes in respective clock hour meridian.
  • 36.
    • Performing indirect slit lamp biomicroscopy
    • Evaluating fundus :
  • 37.  
  • 38.
    • A plano concave non –contact lens
    • High minus power [-55 D]
    • Virtual erect image
    • To visualize - optic cupping , peri papillary changes
    • - Nerve fibre layer thickness [red free filter]
    • - Macular lesion level [slit beam side way
    • movement]
    • [watzke Allen test]
    • - Vitreous opacities, strands.
  • 39.  
  • 40.
    • Concavo plano contact lens - virtual , erect image
    • Combines stereopsis, high illumination, high magnification [ 10 x] , 20 degree field,..
    • Flat central portion – posterior vitreous and pole
    • Angled mirror - 73 deg - area around posterior pole
    • 67 deg - equatorial fundus
    • 59 deg - peripheral retina
    • Eliminates total internal reflection by replacement with cornea – goldmann contact lens interface.
  • 41.  
  • 42. Provides wide field 130 degree and high power lens A real inverted magnified image is formed It is used in both posterior fundus examination and also Laser pan retinal photo Coagulation.
  • 43.
    • THANK YOU

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