The document discusses techniques for examining the optic nerve head using direct and indirect ophthalmoscopy, highlighting the normal characteristics of the optic nerve and methods for identifying potential issues like papilledema. It also outlines preparation steps for conducting a fundus examination, including patient interaction and settings adjustments. Key techniques and contraindications for effective direct ophthalmoscopy are also mentioned.

1. Mohamed Ahmed ELShafie
Lecturer of ophthalmology
Harvard Medical School Almuni
Director of Training Unit
01069201269

4. Viewing
Optic
Nerve
Head
Observe:
 Size: 1.5 mm
 Shape: round to oval
 Color: red-yellow
 Margins: sharp
 C/D ratio: horiz & Vert

5. Papilledema
 Indicates increased
intracranial pressure
due to:
hydrocephalus,
brain tumor or
acute intracranial hemorrhage

7. Optic disc
cupping

8. Vascular Occlusion

9. Methods of Fundus
Examination

10. Fundus Biomicroscopy

11. Indirect
Ophthalmoscopy

13. Direct
Ophthalmoscopy

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

16. Direct Ophthalmoscope

18. Preparation of ophthalmoscope

20. Red reflex

22. • Look for media opacities
• Cataracts
• Corneal scars
• Large floaters

24. Basic skills
• Introduce yourself to the patient.
• Explain the procedure & take the patient permission.
• Sterilization of the hands.
• put mydriatic eye drops to dilate pupils.
• Ask to darken the room.
• Turn on ophthalmoscope, Adjust the focus & Adjust light aperture to large sized pupil.
• Use right eye & right hand for patient’s right eye.
Direct Ophthalmoscopy

25. Why do we
dilate pupils?

26. Basic skills
• Introduce yourself to the patient.
• Explain the procedure & take the patient permission.
• Sterilization of the hands.
• put mydriatic eye drops to dilate pupils.
• Ask to darken the room.
• Turn on ophthalmoscope, Adjust the focus & Adjust light aperture to large sized pupil.
• Use right eye & right hand for patient’s right eye.
Direct Ophthalmoscopy

27. Direct
Ophthalmoscopy
technique:
Observe:
Optic disc Vessels Macula
Peripheral
fundus
Start at optic disc & work
radially
Be systematic

29. Proper position for
peripheral fundus
viewing

30. • Contraindications: head injury
requiring monitoring

32. Preparation of patient

33. Examine Fundus