Direct indirect retinoscope fundus examination fundus microscopy

1. What is funduscopy?
And…
Why is it important to you?
By/Mohamed Ahmed El –Shafie
Assistant Lecturer in ophthalmology department
KafrELShiekh University
E-mail: Shaf3y_h@hotmail.com
facebook/shafie eye clinic
01069201269

2. Review of ocular anatomy

3. Retinal Layers

4. Optic Nerve Anatomy

5. Funduscopy
Techniques/instruments
Direct Ophthalmoscopy
Indirect Ophthalmoscopy
Fundus Biomicroscopy
Fundus Contact Lens

6. Why do we dilate pupils?

7. Direct Ophthalmoscopy
Advantages
 Portable
 Easy to use
 Upright image
 Magnification  15x
 Can use w/o dilation
Disadvantages
 Small field of view
 Lack of stereopsis
 Media opacities can
degrade image

8. Indirect Ophthalmoscopy
Monocular or binocular
Advantages:
 Wide field of view
 Binocular instruments
provide stereopsis
Disadvantages:
 Requires more skill
 Decreased magnification
(3x)
 Requires dilation
 Inverted image

9. Indirect Ophthalmoscopy

11. Fundus Biomicroscopy
Field of View & Mag:
 FOV <indirect but
>direct
 varies w/lens & slit
lamp mag
Inverted image
Stereopsis
Dilated pupil
Requires skill

12. Fundus Biomicroscopy

13. Fundus Contact Lens
Requires physical
contact w/eye
Viewed
w/Biomicroscope
Advanced dx &
surgery
Field of view &
Mag vary w/lens
design

14. Direct Ophthalmoscopy:
Basic skills
Viewing ocular
media
 Observe red reflex
 Look for media
opacities
 Cataracts
 Corneal scars
 Large floaters

15. Direct Ophthalmoscopy:
Basic skills
Proper position for
central fundus
viewing
Right eye to right
eye
Left eye to left eye
Don’t rub noses…

16. Direct Ophthalmoscopy:
Basic skills
Proper position for
peripheral fundus
viewing

17. Direct Ophthalmoscopy:
Exam technique
Be systematic
Start at optic disc & work radially
Observe:
 Optic disc: C/D ratio
 Vessels: course & caliber, AV ratio, light
reflex, crossings/banking
 Macula
 Peripheral fundus

18. Normal Fundus

19. Viewing the Optic Nerve Head
Observe:
 Size
 Shape
 Color
 Margins
 Cup to disc ratio (C/D) horiz & Vert

20. Blood Vessel Evaluation
Observe:
 Vessel diameter
 Shape/tortuosity
 Color
 Crossings
 Light reflex
 Artery/Vein (A/V) ratio: after 2nd bifurcation

21. Hypertensive Retinopathy
Scheie classification:
I: Thinning of retinal arterioles relative to
veins
II: Obvious arteriolar narrowing w/focal areas
of attenuation
III: Stage II + cotton wool spots, exudates &
hemes
IV: Stage III + swollen optic disk (similar to
papilledema)

22. Vessel “Crossings”
Normal crossing
Direction change
“banking’” or “nipping”

23. Retinoblastoma
 There is a white reflex,
rather than red reflex
when illuminated
 Red reflex is also
reduced in cataract

24. Papilledema
 Indicates increased
intracranial pressure, e.g.
due to hydrocephalus,
brain tumor, idiopathic
intracranial hypertension
or acute intracranial
hemorrhage

25. Proliferative retinopathy and
cotton-wool spots
Cotton-wool spots are
caused by ischemic
damage to nerve fibers
Compensatory
proliferation of vessels
Diabetes and
hypertension are the
main causes

26. Age-related Macular Degenetation
 Wet form: abnormal blood
vessel growth w/ hemorrhage
and protein leakage
Dry form: Drusen
(cellular debris) build-up