Indirect ophthalmoscopy
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Indirect ophthalmoscopy is a technique used to examine the back of the eye. The key steps are: 1) Adjusting the ophthalmoscope and positioning the patient lying down looking directly up. 2) The examiner stands to the side and holds the lens about 2 inches from the patient's eye to focus the view. 3) By tilting their head and walking around, the examiner views different parts of the retina, instructing the patient to look in various directions. The macula is examined last when cooperation may be reduced.
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1) Assessment of eyelid position, symmetry, closure, and measurements like interpalpebral fissure height.
2) Evaluation of proptosis using an exophthalmometer to measure distance from orbital rim to corneal apex.
3) Examination of the lacrimal system including the puncta, sac, and tear drainage using tests like dye disappearance and Jones tests.
Near point of convergence
The near point of convergence is defined as the point of intersection of the lines of sight of the eyes when maximum convergence is used. It is measured as the distance from this point of intersection to the midpoint between the eyes. Measuring the near point of convergence involves having a patient fixate on a target that is slowly moved toward them while maintaining fusion until their eyes can no longer converge or they see double. This distance is used to assess a patient's ability to converge their eyes for near vision tasks. A near point further than 10cm may indicate convergence insufficiency while one closer than 5cm suggests convergence excess.
Binocular Indirect Ophthalmoscopy
Binocular indirect ophthalmoscopy (BIO) allows examination of the retina using a condensing lens held close to the eye. It provides a stereoscopic, wide-field view of the retina. Mastering BIO takes practice due to its technical challenges. Key steps include properly dilating the eye, positioning the patient, choosing the right lens based on desired magnification and field of view, minimizing lens distortions, adjusting the indirect headset, and depressing the sclera for a dynamic view of the peripheral retina.
Ophthalmoscopy
This document provides an overview of various ophthalmic instruments used in eye examinations, including:
1. Direct and indirect ophthalmoscopes are used to examine the interior of the eye. Indirect ophthalmoscopy uses a condensing lens to form an erect, magnified image of the retina.
2. The slit lamp examination uses different illumination techniques like diffuse, direct, and retroillumination to examine the anterior segment of the eye including the eyelids, cornea, iris, and lens.
3. Indirect techniques like specular reflection and optical sectioning are used to examine corneal structures at high magnification.
4. A lensometer is used to measure the refractive power of correct
Hess chart, diplopia chart, cover tests
This document discusses various tests used to evaluate binocular vision, including cover tests, Hess charting, and diplopia charting. Cover tests are used to detect manifest or latent strabismus and determine deviation direction. Hess charting maps eye positions in 9 gazes using colored lenses to dissociate vision between eyes. It identifies muscle under or overaction. Diplopia charting records double vision separation in 9 gazes to localize affected muscles. These objective tests evaluate binocular function and strabismus type and localization.
Diplopia charting
Diplopia charting involves recording the separation of double images seen by a patient in nine positions of gaze. The examiner uses a red glass over one eye while holding a light source in different positions. The patient reports if they see one image, two separate images, or a tilted image. The separation is greatest in the direction of an underacting or paralyzed eye muscle. When recording the results, the patient's right and left sides are noted along with the distance of any separation between images and any tilting. The diplopia chart should be interpreted along with a clinical exam and Hess chart.
Techniques of fundus
Techniques of fundus examination include direct ophthalmoscopy, indirect ophthalmoscopy, and slit-lamp biomicroscopic examination using various lenses. Direct ophthalmoscopy provides an upright 15x magnified view of the fundus but has a limited field of view. Indirect ophthalmoscopy uses a condensing lens to produce an inverted real image with a wider field of view, allowing examination of the peripheral retina. Slit-lamp biomicroscopy employs contact lenses or small diameter lenses like a +78D or +90D to provide magnified views of the posterior pole under illumination.
Synaptophore in ophthalmology
The synaptophore is a device used to measure binocular vision anomalies. It consists of two optical tubes that can be adjusted horizontally, vertically, and torsionally. Various slides are used for diagnostic and treatment purposes to measure deviations, fusion, stereopsis, and retinal correspondence. Key measurements include the objective and subjective angles of deviation in different gazes, as well as the fusional ranges in horizontal, vertical, and torsional planes. Suppression can also be detected and mapped out. Precise adjustments of the tubes allow customized orthoptic treatment of binocular vision disorders.
Subjective refraction
This document discusses various techniques for subjective refraction including determining the best vision sphere and using the duochrome test. It provides details on:
1. Using plus and minus lenses to find the maximum plus or minimum minus that can be tolerated without blurring vision, known as the best vision sphere.
2. The duochrome test which takes advantage of chromatic aberration, using a split red-green filter to refine the endpoint by comparing clarity on red and green backgrounds.
3. Additional methods like pinhole and fogging are described to control accommodation and improve accuracy.
INDIRECT OPHTHALOMOSCOPE
Indirect ophthalmoscopy requires practice to master. The summary provides steps to properly perform indirect ophthalmoscopy:
1. Dilate the patient's eyes well using tropicamide and phenylephrine. This allows for a good peripheral exam.
2. Position the patient laying flat or partially upright to allow viewing different areas of the retina. Tilting the head also helps with viewing.
3. Use a 20D lens for general exams and a 30D lens initially for the ora serrata. Hold lenses correctly and focus by moving them in and out.
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Treatment Strategies for Routine Binocular Vision Problems
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Eyelid, Lacrimal System, and Orbital Examination (1).pptx
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Indirect ophthalmoscopy
- 16. Technique to Perform BIO • Adjustment of the ophthalmoscope • Adjust headband crown • Adjust the pupillary distance • Check illumination intensity. Usually start with lower illumination and slowly increase illumination as needed and as tolerated by the patient. Check for a proper elevation/position. Check can be done by extending arm or by looking at a wall. • Apply filter if desired • Positioning the patient - Patient should be in a supine position • Patient should be looking directly up, initially (primary position) • Examiner should initially stand to the side of the patient, leaning over the patient • Keep handheld lens approximately 2 inches away from patient's eye, moving it closer or farther away to focus and refine the view • Examiner swivels his view around to view different parts of the retina, by tilting the head and walking around the patient • The doctor instructs the patient to look at various extremes of their vision • The macula is examined at the last, as the light is bright and patient cooperation for BIO may reduce drastically if macula is examined at the initiation of BIO
- 23. .
- 83. • The retinal nerve fiber layer contains ganglion cell axons that run toward the optic disc, with the temporal fibers following a arcuate course around the fovea. • The retinal nerve fiber layer is seen as bright striations and is most easily visible where it is thickest, at the vertical poles of the optic disc
- 87. ..
Editor's Notes
- About 2.5 times magnification and 35 degrees or 8DD field of view is obtained with a +20D lens. With a stronger lens, image will be smaller but brighter and field of view will be more.
- The magnification of a specific BIO lens is crudely determined by 60/the power of lens. Thus, a +20D lens would have a magnification of 60/20= 3X. 20D lens is the most commonly used lens for BIO in adults. For examination of retinopathy of prematurity patients, 28D lens is preferred.