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.
complete information about the retinal detachment , types, , symptoms , sign, etiology, causes, diagnosis, complications, medical management, nursing management, home care, patient teaching. nursing reserch.
This is a seminar presentation conducted by 4th year medical student under supervision of a lecturer. This is for ophthalmology posting seminar. Source of information are from google, few textbooks and also based on previous ophthalmology posting group's seminar.
complete information about the refractive errors due to the problem in the acomodation of eye lense , disturbed image formation in the retina, contains -types of disease condition .
About awareness of eye donation. Author is assistant professor in Ayurvedic Ophthalmology MES Ayurved Mahavidyalaya and consulting ayurvedic ophthalmologist at Shree Vyankatesh Netralay Chiplun.
complete information about the retinal detachment , types, , symptoms , sign, etiology, causes, diagnosis, complications, medical management, nursing management, home care, patient teaching. nursing reserch.
This is a seminar presentation conducted by 4th year medical student under supervision of a lecturer. This is for ophthalmology posting seminar. Source of information are from google, few textbooks and also based on previous ophthalmology posting group's seminar.
complete information about the refractive errors due to the problem in the acomodation of eye lense , disturbed image formation in the retina, contains -types of disease condition .
About awareness of eye donation. Author is assistant professor in Ayurvedic Ophthalmology MES Ayurved Mahavidyalaya and consulting ayurvedic ophthalmologist at Shree Vyankatesh Netralay Chiplun.
Retina (Define ,anatomy of retina, examination of retina, classification of ...Maryam Fida
Retina
The retina is a layer tissue at the back of the eye that senses light and sends images to the brain. In the center of this nervous tissue is the macula, that allows to focus the view toward the center and provides the needed sharpness to read, drive and clearly see details.
The retina processes light through a layer of photoreceptor cells. These are essentially light-sensitive cells, responsible for detecting qualities such as color and light-intensity. The retina processes the information gathered by the photoreceptor cells and sends this information to the brain via the optic nerve. Basically, the retina processes a picture from the focused light, and the brain is left to decide what the picture is.
Layers of Retina
The retina can be divided into 11 layers including
1. the inner limiting membrane
2. the nerve fiber layer
3. the ganglion cell layer
4. the inner plexiform layer
5. the inner nuclear layer
6. middle limiting layer
7. the outer plexiform layer
8. the outer nuclear layer
9. the outer limiting membrane
10. the photoreceptor layer
11. The retinal pigmented epithelium (RPE) monolayer.
Ora serrata
Anterior termination of retina where it continues with epithelium of Ciliary body.
Macula lutea (yellow spot)
1.5mm diameter area at post. Pole about 3mm temporal to optic disc.
Fovea centralis
Small depression in centre of macula
Cones predominate in this area
Most sensitive part of retina
Figure 1 Normal fundus Vessels emerge from nasal side of disc. Arteries are narrower than veins
Examination of Retina
Direct & indirect Ophthalmoscopy
1. Darken room, ask patient to look at the same point as far as possible in the room (this will help to dilate the pupil).
2. Wedge scope against your cheek with hand and then head/hand/scope should move as one unit.
3. Use your right hand & your right eye to look at the patient’s right eye. (Less important if using the PanOptic.)
4. Look through the ophthalmoscope, if you are nearsighted and have taken off your glasses, you may need to adjust the focusing wheel towards the negative/red until what you see at a distance is in focus.
5. Direct the ophthalmoscope 15 degrees from center and look for the red reflex (see video). Simply follow the red reflex in until you see the retina. If you lose the red reflex, come back until you find it again and repeat.
6. To look around the retina using a traditional direct ophthalmoscope, you should "pivot" the ophthalmoscope, angling up, down, left and right. If using the PanOptic, you can slightly "pivot" or ask the patient to look up to see upper retina, down to see lower retina, medial to see medial, latereral to see lateral and finally to look at the light to visualize the macula.
Slit Lamp Binocular Indirect Ophthalmoscopy
The use of slit lamp BIO is an increasingly popular form of fundoscopic examination. Minimum a dilated fundus examination with an indirect lens should be carried out on those presenting with photopsi
this ppt contains detailed information about the direct opthalmoscopy, how to use and how to interpret the certain ocular conditions like cataracts, retinal changes, any medial opacities
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.
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.
5.
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.)