Ophthalmoscopy

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Ophthalmoscopy

  1. 1. 26/04/2010 OPHTHALMOSCOPY Dr Frank FAMOSE DVM, CES Ophtalmologie Ekaterinburg May 2010What is ophthalmoscopy ?►Fundus examination ►Direct  Tapetum ophthalmoscopy  Non-tapetal zone  Vascularisation ►Indirect  Optic nerve papilla ophthalmoscopy ►Skiascopy 1
  2. 2. 26/04/2010Indications► Diagnosis ► Inherited ocular disease surveyDIRECTOPHTHALMOSCOPY 2
  3. 3. 26/04/2010Principles of ophthalmoscopyHistory►1704 : First description of feline ocular fundus►1846-1854 : Babbage-Wharton-Jones►1858 : First use of direct ophthalmology in animals►1892 : First atlas of veterinary ophthalmoscopy 3
  4. 4. 26/04/2010Material►Handheld devices►Low price Animal’s side Operator’s sideDirect ophthalmoscopy : technicalaspects 4
  5. 5. 26/04/2010What do you see ?►Image size  Magnification from x17 to x19  Comparison to optic disc (vision field about 2-3 Odisc)► Image position  Real image  Erect imagePractical realization►Animal restraint►Sedation 5
  6. 6. 26/04/2010Practical realization►Dilatation  Tropicamide 0,5%  1 drop ev. 5 min for 20 min►Dark roomPractical realization : step by step►What to do ? ►How to do ? Place the ophthalmoscope on  Place it against your right brow your eye (for exam of right eye) Look for the Fundus reflexion  Look for it from a 0,5 to 0,75 m (green reflex) distance Get closer  Till the Fundus is full field Follow eye movements ►Difficulties ?  Keep both eyes opened  Right for right, left for left  Don’t lose fundus reflexion 6
  7. 7. 26/04/2010Systematic examination of fundusTapetum Retinal VesselsNon tapetal Optic Zone DiscSystematic examination of fundus First Second quadrant quadrant Fourth Third quadrant quadrant 7
  8. 8. 26/04/2010Adjustements►Rekoss disc  Description -2  Uses►Light source size►Light colour►Grille►Slit source 15Pros and cons of directophthalmoscopy►Pros ►Cons Greater magnification  Small field of view Grid and slit  Short working distance Alteration of dioptric  Monocular vision power  Bad vision of peripheral Lower cost retina  Greater distorsion if opacities 8
  9. 9. 26/04/2010INDIRECTOPHTHALMOSCOPYPrinciples of ophthalmoscopy 9
  10. 10. 26/04/2010History►1853 : Ruete►1947 : Development in human medicine►1960 : Veterinary useIndirect ophthalmoscopy :technical aspects 10
  11. 11. 26/04/2010Equipment►Light source  Electric lamp  Headband fit►Optic system  Converging lens  PrismsEquipment : digital fundus camera 11
  12. 12. 26/04/2010Practical realization►Animal restraint►SedationPractical realization►Dilatation  Tropicamide 0,5%  1 drop ev. 5 min for 20 min►Dark room 12
  13. 13. 26/04/2010 Practical realization : step by step ►What to do ? ►How to do ? Place the ophthalmoscope on  Adjust pupillary space and your head direction of light source Look for the Fundus reflexion  Look for it from a 0,5 to 0,75 cm (green reflex) distance Place the lens 2-3 cm from the  Move it till the Fundus is full field eye Follow eye movements ►Difficulties ?  Placement of lens  Inversion of movements  Don’t lose fundus reflexion Systematic examination of fundus Tapetum Retinal Vessels Non tapetal Optic Zone Disc 13
  14. 14. 26/04/2010 Systematic examination of fundus First Second quadrant quadrant Fourth Third quadrant quadrantNormal fundus - Dog 14
  15. 15. 26/04/2010Normal fundus - DogNormal fundus - Dog 15
  16. 16. 26/04/2010Normal fundus - DogNormal fundus - Dog 16
  17. 17. 26/04/2010Retinal degeneration - CatCentral retinal atrophy - Dog 17
  18. 18. 26/04/2010Retinal detachement - Dog Adjustements : lenses ►Plan-convex lens : converging effect ►Effect of power of lens  On magnification  On visual field 36 18
  19. 19. 26/04/2010Pros and cons of indirectophthalmoscopy►Pros ►Cons Larger field of view  Inversion of image Safer distance from the  Less magnification patient  Technically more Binocular evaluation difficult  More expensiveConclusion►Ophthalmoscopy : essential part of eye examination►Direct and indirect complements each other►Practice, practice, practice… 38 19

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