Presentation describing the technique used in direct fundoscopic/opthalmoscopic exam, with some illustration of common pathologies as well as the use of fluorescein to reveal corneal injuries.
Note: there is a typo on slide 7. This slide should instead read "Central Serous Retinopathy (CSR)".
Sources for all imagery and sources listed in references section where possible. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.
9. Direct
Ophthalmoscopy
• This method is far more commonly seen in general
practice/outpatient clinics
• Handheld device with multiple settings
10.
11. Correct technique
• When examining patient’s RIGHT eye, hold the scope in
your RIGHT hand and use your RIGHT eye to view
• Steady the patient’s head with left hand
• Begin with scope ~15cm from patient and find red reflex,
then move closer
• Adjust focus with dioptre lens to view optic nerve
• Scan up, down, left and
right to visualise vessels,
and move farther to
visualise the macula and
fovea
• Repeat the same
technique with the left
eye, reversing your hands
and viewing eye
12. Pupillary dilation
• Some practitioners use midriatic eye drops, such as
tropicamide 0.5%, an antimuscarinic agent, to dilate the
pupil and allow easier examination of the fundus
• This is not always done, and sometimes avoided due to
the possibility of precipitating an acute closed angle
glaucoma, although the risk is typically minor
13. Fluorescein
• Non-irritating dye used to stain the cornea to allow
easier identification of damage/injury
• Ophthalmoscope not required, but blue light
extremely useful
16. References
1. Moran Eye Centre (2018), ‘How to use the Direct Ophtalmoscope’,
MoranCore Ophthalmology Resource, accessed at
http://morancore.utah.edu/basic-ophthalmology-review/how-to-use-the-
direct-ophthalmoscope/ on 14/10/2020
2. University of Iowa Healthcare (2016), ‘Fluorescein staining of the cornea’,
EyeRounds.org, accessed at
https://webeye.ophth.uiowa.edu/eyeforum/atlas-video/fluorescein-
staining.htm on 20/10/2020
3. Tapsell, S. (2011), ‘Fluorescein’, Eye Learning, accessed at http://eyes.gp-
surgery.com/key-skills/fluorescein/ on 20/10/2020
4. American Diagnostic Corporation (2020), ‘How to Use an
Ophthalmoscope’, accessed at https://www.adctoday.com/learning-
center/about-ophthalmoscopes/how-use-opthalmoscope on 13/11/2020
5. Das, J.M. (2014), ‘Direct Ophthalmoscopy’, SlideShare, accessed at
https://www.slideshare.net/joemdas/direct-
ophthalmoscopy?qid=248ff6ef-4691-4724-a554-
4a008c01f76d&v=&b=&from_search=1 on 13/11/2020
6. Surendran, A. (2009), ‘Principles of Ophthalmoscopy’, SlideShare,
accessed at https://www.slideshare.net/draswinikumars/principles-of-
ophthalmoscopy on 13/11/2020
7. Mayo Clinic (1998), ‘Diabetic retinopathy’, accessed at
https://www.mayoclinic.org/diseases-conditions/diabetic-
retinopathy/symptoms-causes/syc-20371611 on 13/11/2020
17. References, contd.
8. Varma, D., Cugati S. (2013), ‘A review of central retinal artery occlusion:
clinical presentation and management’, Eye 27: 688–697
9. Higgins, G., ‘Diabetic Neuropathy’, accessed at
http://www.higginseyesurgeon.com/diabetic-retinopathy.html on 13/11/2020
10. NeoVision Eye Centre, ‘Direct Opthalmoscope’, accessed at
https://www.neovisioneyecenters.com/our-
technologies/ophthalmoscopy/direct-ophthalmoscope/ on 13/11/2020
11. Stanford School of Medicine, ‘Fundoscopic / Ophthalmoscopic Exam’,
Stanford Medicine 25, accessed at
https://stanfordmedicine25.stanford.edu/the25/fundoscopic.html on
16/11/2020
12. Liew, G., Mitchell, P., Yin Wong, T. (2006), ‘Fundoscopy: to dilate or not to
dilate?’, British Medical Journal 332: 7532
13. University of Iowa Healthcare (2016), ‘Central Serous Retinopathy (CSR)’,
EyeRounds.org, accessed at
http://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/central-serous-
retinopathy-csr.html on 17/11/2020