you will get information and knowledge about the direct ophthalmic instrument known as ophthalmoscope. its principle, parts, types, its different filters, techniques, uses, and its method is explained in these slides.

2. Direct
Ophthalmoscope
By
Anam
Sehreen
Doctor of
Optometry

3.  Ophthalmoscopy, also called funduscopy, is a test that
allows a health professional to see inside the fundus of
the eye and other structures using an ophthalmoscope
(funduscope).
 It is done as:
 Part of an eye examination
 Part of a routine physical examination
Direct Ophthalmoscope

4. OPHTHALMOSCOPE
 Ophthalmoscope is a hand held instrument used to
examine the fundus.
 It is used monocularly.
 It can be used to examine central 7-10 degree of
retina.
 It gives a magnification of 15x which makes the 1.5mm
disc appear much larger.

5. PRINCIPLE

6. PRINCIPLE
 The instrument consists of a system of lenses which
focus light from an electric bulb on to a mirror where
a real image of the bulb filament is formed.
 The mirror reflects the emitted light in a diverging
beam which is used to illuminate the patient's eye.
 The mirror contains a hole through which the
observer views the illuminated eye.
 The image of the bulb is formed just below the hole
so that its corneal reflection does not lie in the visual
axis of the observer.

7. DIRECT OPHTHALMOSCOPE

8. FIELD OF VIEW
 The area of retina which can be seen at any one time
is called the field of view.
 It is governed by the projected image of the sight-
hole on the retina (the sight-hole being the hole in
the mirror or the observer's pupil, whichever is the
smaller).

9. SYSTEMS OF OPHTHALMOSCOPE
Ophthalmoscope consist
of two system
 Illuminating system
 Viewing system

10. METHODS OF EXAMINATION
 Distance direct ophthalmoscopy
 Direct ophthalmoscopy

11. DISTANT DIRECT OPHTHALMOSCOPY
 It is used to get a preliminary idea about the status of
the ocular media and fundus
 This should be done routinely before doing a direct
ophthalmoscopy
 Equipment needed:
 Self illuminated ophthalmoscope or plane mirror with
a hole in center

12. PROCEDURE
 Should be performed in a semi dark room
 The ophthalmoscope should be kept at a distance
of 20-25 cm from the patient’s eye
 Normally a red reflex is seen at the pupillary area

13. USES
1. To diagnose opacities in refractive media
2. To differentiate between a mole on the iris and
a hole in the iris
3. To detect a retinal detachment or fundal mass

14. OPACITIES IN REFRACTIVE MEDIA
 Opacities in the ocular media are seen as dark spots
in the red glow at the pupillary area
 The plane of the opacities can be assessed by asking
the patient to move the eye from side to side while
the examiner is observing the pupillary glow (based
on parallax principle)

15. OPACITIES IN REFRACTIVE MEDIA
 Opacities in front of the pupil move in the direction
of eye movement
 Opacities in the pupillary plane do not move
 Opacities behind the pupillary plane move opposite
the direction of eye movement

16. BRUCKNER TEST

17. Mole on iris and hole in iris
 To differentiate between a mole on the iris and
a hole in the iris in distant direct
ophthalmoscopy
 Mole – appears dark
 Hole – red glow is seen

18. RD or fundal mass
 To detect a retinal detachment or fundal mass
 Both of them are visible as a grayish reflex
 It is not possible to differentiate them in distant
direct ophthalmoscopy

19. DIRECT OPHTHALMOSCOPY

20. TYPES OF OPHTHALMOSCOPES
 Traditional Direct Ophthalmoscope
 Pan Optic Direct Ophthalmoscope

21. PAN OPTIC DIRECT OPHTHALMOSCOPE
 Fast, easy entry into small, un-
dilated pupils
 25° field of view versus the 5°
field of view of standard
ophthalmoscopes
 5X larger view of the fundus vs.
standard ophthalmoscopes in an
un-dilated eye
 Greater working distance
improves comfort for practitioner

22. OPHTHALMOSCOPE SETTINGS
 Aperture/Filter Dial
 The aperture/filter dial allows the ophthalmoscope to
be used for different purposes.
 Half light:
 If, for example, the pupil is partially obstructed by a
lens with cataracts, the half circle can be used to pass
light through only the clear portion of the pupil to
avoid light reflecting back.

23.  Large/Medium/Small light source:
 Ophthalmoscopes usually have 2-3 sizes of light to
use depending on the level of pupil dilation.
 The small light is used when the pupil is very
constricted (i.e. well lit room, no pupil dilators used).
 The large light is best if using mydriatic eye drops to
dilate.
 Most commonly in a dark, non-dilated pupil, the
medium sized light is used.

24.  Red free: Used to visualize the vessels and
hemorrhages in better detail by improving contrast.
This setting will make the retina look black and white.
 Slit beam: Used to examine contour abnormalities of
the cornea, lens and retina.
 Blue light: Some ophthalmoscopes have this feature
that can be used to observe corneal abrasions and
ulcers after fluorescein staining.
 Grid: Used to make rough approximations of relative
distance between retinal lesions.

26. TECHNIQUE --> FINDING THE RETINA
 Darken room, ask patient to look at the same point as
far as possible in the room (this will help to dilate the
pupil).
 Wedge scope against your cheek with hand and then
head/hand/scope should move as one unit.
 Use your right hand & your right eye to look at the
patient’s right eye (Less important if using the Pan
Optic).

27.  Look through the ophthalmoscope, if you are
nearsighted and have taken off your glasses, you may
need to adjust the focusing wheel towards the
negative/red until what you see at a distance is in
focus.
 Direct the ophthalmoscope 15 degrees from center
and look for the red reflex.
 Simply follow the red reflex in until you see the retina.
If you lose the red reflex, come back until you find it
again and repeat.

28.  To look around the retina using a traditional direct
ophthalmoscope, you should "pivot" the
ophthalmoscope, angling up, down, left and right.
 If using the PanOptic, you can slightly "pivot" or ask the
patient to look up to see upper retina, down to see
lower retina, medial to see medial, latereral to see
lateral and finally to look at the light to visualize the
macula.

29. DILATING THE PUPIL FOR THE
FUNDOSCOPIC EXAM
 Mydriatic drops
 Dilate one eye when you start your H & P and by the
time you are done you will have a good look. In
general Tropicamide is considered the safest.
 Parasympathetic antagonists:
 Paralyze circular muscle of iris (mydriasis) and the
ciliary muscle (loss of accommodation).

30. MYDRIATIC DROPS
 Tropicamide: 1-2 drops (0.5%) 15-20 minutes
before exam; may repeat every 30 minutes PRN.
Individuals with heavily pigmented eyes may
require larger doses.
 Cyclopentolate: 1 drop of 1% followed by another
drop in 5 min; 2% solution in heavily pigmented
iris.
 Atropine: (1% solution): Instill 1-2 drops 1 hour
before the procedure.
 Homatropine: 1 drop of 2% solution immediately
before the procedure; repeat at 10 min intervals
PRN.

31. SYMPATHETIC AGONISTS
 Phenylephrine: 1 drop of 2.5% or 10% solution, may
repeat in 10-60 min PRNs

32. CLINICAL IMAGES OF THE RETINA
 Normal fundus
 Pathological Optic Cupping
 Optic Disc Edema
 Arterio-Venous (AV) Nicking
 Cotton Wool Spots