This document provides instructions for examining a patient's fundus using an ophthalmoscope. It describes how to position the patient and ophthalmoscope, how to focus on different parts of the fundus including the optic disc, blood vessels, periphery, and macula, and what features to assess for each area such as shape and clarity of the optic disc or signs of hypertensive retinopathy. The goal is to be able to properly examine the fundus and recognize common abnormalities.

1. NELSON.R.MANDELA SCHOOL OF MEDICINE
2012

2.  For this module, you need to be able to examine the
fundus – on a model or a simulated patient - know
the features and significance of papilloedema, and be
able to recognise it clinically.
 You should also become familiar with other common
abnormalities such as optic atrophy, hypertensive and
diabetic retinopathy and retinitis pigmentosa – look
at illustrations in your textbooks eg Talley Page 299
 Note that we also have panoptic as well as standard
ophthalmoscopes available in the Skills Lab. You
must, however, be competent in the use of the
standard opththalmoscope.

3.  a

4.  Explain the procedure to the patient.
 Dim the lights in the room.
To examine the right eye, you must:
 Sit on right side of the patient.
 Use your right eye to look into the patient’s
right eye.

6.  Turn the ophthalmoscope on.
 Rotate the rheostat to the desired light output . You
may start at full illumination and reduce it to a level
that is comfortable to the patient.
 Select 0 on the lens dial. (If you wear
spectacles, remove these and use the
ophthalmoscope to correct your vision by focusing on
an object 3-4 metres away and selecting the lens
which provides the best focus for you)
 Select the correct aperture
 You may start with the small aperture and lower light
intensity to avoid patient discomfort, but ultimately
use the largest possible aperture for good viewing of
the retina.

7. • Hold the ophthalmoscope in your right
hand, vertically in front of your right eye.
• Place your index finger on the lens dial to
enable you to change lenses easily in order to
focus.
• Instruct the patient to look straight ahead
and focus on an object in the distance.

8. • Place your left hand on the patient’s
forehead, using your left thumb to hold the
patient’s right upper eyelid open.
• Position the ophthalmoscope +/- 15cm
away from and 25 degrees to the right of the
patient.
• Direct the light beam onto the pupil as
you move towards the eye.

9. • The red reflex should appear as you look
at the pupil.
• Keep the reflex in view, as you move
slowly closer to the patient’s eye.
• When you are +/- 5cm away from the
eye, the optic disc should come into view (or
locate and follow a large retinal vein back
towards the disc - all vessels radiate from the
optic disc.)

10.  Rotate the lens dial until the optic disc is focused
clearly.
(Red numbers/negative numbers in myopia or short-
sightedness.
Green numbers/positive numbers in hyperopia or far-
sightedness.)
 Examine the optic disc for:
Shape – normally round or slightly oval
Clarity of the outline-clear outline or rim
Colour-rich yellow contrast to rich red of rest of
fundus
Elevation –disc is a shallow (physiological) cup
Condition of vessels

11.  Follow each vessel as far to the periphery as you
can
 Ask the patient to look up, down, temporally and
nasally and move as necessary as well to examine all
areas of the retina, making sure to examine all 4
quadrants.
 The procedure is made difficult if the light is
reflecting off the patient’s cornea, into your eye
(corneal reflection). Use the appropriate filter
(crossed polarising filter) to reduce this reflection.

12.  Examine the macula last.
 To locate the macula, focus on the disc, then
move 2 disc diameters temporally. The
macula is darker in colour than the
surrounding fundus, and devoid of blood
vessels.
 You may also ask the patient to look at the
light. This automatically puts the macula into
full view.

13.  Do the opposite to examine the patient’s left
eye.

14. 1)The optic disc
2)The retinal blood vessels
3)The periphery of the fundus
4) The macula
(Assess the vessels and look for other
abnormalities such as hypertensive or diabetic
retinopathy.)

15.  a

18.  MGM - updated 2012-02-27
 Year 3
 Clinical Skills
 Fundoscopy protocol - Practical approach