The direct ophthalmoscope is a handheld instrument used to examine the fundus monocularly within a central 7-10 degree retinal area. It provides 15x magnification. It has illumination and viewing systems, including tungsten bulbs, lenses, filters and apertures to examine the retina, optic disc, vessels, macula and other structures. Key aspects include assessing the optic disc size and color, cup-to-disc ratio, macula, vessels and looking for abnormalities. It allows gross anterior segment examination with additional lenses.

1. Presented by: Chodup

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

3.  Illuminating system
 Viewing system
 Illumination system consist of:
tungsten bulb
condensing lens
a reflector/ prism
apertures stop and filters

4.  Viewing system consist of:
-sight hole
-focusing system
Rack of lenses of different powers in the form
of a wheel or chain to compensates for the
refractive states of the examiner and the
patient and accessory filters.

5. -Red free filter
-Cobalt blue filter
Apertures
-large aperture
-small aperture
-semicircle
-streak
-linkz star(fixation star)

6.  The red free in the ophthalmoscope is use to
differentiate between retinal and choroidal
lesion.
 It also makes small macro aneurysms and
small hemorrhage standout more clearly and
helpful in estimating C/D ratio.
 Large aperture is used to examine the fundus
through the dilated pupil.
 Small aperture is used to examine the fundus
with small pupil.

7.  Semi circle aperture is used to avoid fundus
reflection while examining the fundus.
 The grid with small star in the centre is used
to find out the eccentric fixation.

8.  The OD is oval/ round & measure about 1.5mm.
Healthy OD appears pinkish orange in color.
Yellowish appearance of the OD is suggestive of
optic atrophy. The small spot of light in direct
ophthalmoscope intended to be approximatly one
disc diameter in size. Place the spot on the disc &
observe how much of the disc is filled up. If the
disc is fully fills the spot of light & matches its
size this would indicate a normal disc size.

9.  Shape
 Color
 Clarity of margins
 Cup-Disc (C/D)ratio
 Venous pulsation
-it is absent in approximately 20% of normal
individual.

10.  The fovea is located approximately 3mm temperol
The fovea acts like a concave mirror & gather s the
light from the ophthalmoscope & presents as a
sharp reflex called foveal reflex.
 It should always recorded as FR present or absent.
If is dull, it is recorded as Dull FR.
 Macula is dark pigmented area around the foveal
reflex.
Macula should be examined for
-presence of drusen
-pigmentary changes
-elevation(edema)

11.  Examine the vessels & branches as they come out
of disc. Examine atery to vein (A/V)ratio,
branching of vessels to all four quadrants crossing
etc. Normal A/V ration is 2/3.

12. Pupil
- pupil can be evaluated by comparing the size & shape.
Media Opaciities
-anything that interferes with the reflecting light from
the retina like cataract, floaters, corneal scars etc can be
seen as black spots.
Anterior Segment
-with +13 to +15D lens in the ophthalmoscope cornea,
lids, sclera, lashes,& iris can be grossly examine.
Vitreous
-with +6or+7D lens in the ophthalmoscope vitreous
floaters, &vit opacities can be seen.

13.  First you have to explain the patient about the
procedure. It should be perform in a semidark
room.
 The patient’s right eye should be examine with
the examiner right eye & right hand.
 Give the pt a fixation target.
 Start from a one arm length & move as close as
possible to the pt’s.
 First trace the optic disc & follow the vescular
arcades & finally move to the macula & other as
you wish to examine.
 Do not put your hand on pts head or shoulder
which pt uncomfortable.

14.  It is relatively easy procedure to master as compare
to IO.
 IT has the greatest amount of magnification of any
procedure used for fundus examination.
 By using the lens wheel to adjust focus, the
clinician is able to examin the various structures of
the eye.
 It can be used in non dilated pupil.
Disadvantages
 Limited field of view & monocular view.
 A steroscopic view is not possible.

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