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.

1. Direct ophthalmoscopy/fundoscopy
Dr. Robert Ferris

2. Direct Indirect
Two distinct methods of
ophthalmoscopy

3. • The ophthalmoscope is used to examine the
vitreous humor and fundus of the eye to assess
the health of the retina, optic nerve and
vasculature

4. Diabetic retinopathy
note characteristic “dot” and “blot” haemorrhages

5. Diabetic retinopathy
note “cotton wool spots”

6. Central retinal artery occlusion

7. Central Serious Retinopathy
(CSR)

8. Papilloedema

9. Direct
Ophthalmoscopy
• This method is far more commonly seen in general
practice/outpatient clinics
• Handheld device with multiple settings

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

14. Corneal abrasion

15. Dendritic ulcer
seen in herpes simplex keratitis

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