An overview of ophthalmoscopy

1. OPHTHALMOSCOPY
PRESENTED
BY
CHIOMA GOODNESS EZEH
CMS/FBM/ANA/18/41557
FACULTY OF BASIC MEDICAL SCIENCES
DEPARTMENT OF HUMAN ANATOMY

2. TABLE OF CONTENT
 INTRODUCTION
 HISTORY OF OPTHALMOSCOPY
 TYPES OF OPHTHALMOSCOPY
 TYPES OF OPHTHALMOSCOPE
 DILATION OF THE PUPIL
 EFFECT OF OPHTHALMOSCOPY
 WHY THE TEST IS PERFORMED
 RISK
 SUMMARY
 REFERENCES

3. INTRODUCTION
 Ophthalmoscopy, also called Funduscopy, is a test that
allows a health professional to see inside the fundus of
the eye and other structures using an ophthalmoscope
(funduscope). It is done as part of an eye examination
and may be done as part of a routine physical
examination. It is crucial in determining the health of the
retina, optic disc and vitreous humor.
 The pupil is a hole through which the eye’s interior will
be viewed. Opening the pupil wider (dilating it) is a
simple and effective way to better see the structures
behind it. Therefore, dilation of the pupil (mydriasis) is
often accomplished with medicated eye drops before
funduscopy. However, although dilated fundus
examination is ideal, indilated examination is more
convenient and is also helpful (albeit not as
comprehensive), and it is the most common type in
primary care.
 An alternative or complement to ophthalmoscopy is to

4. HISTORY OF OPTHALMOSCOPY
 Dr. William Cumming in 1846 at the Royal London Ophthalmic
Hospital (later Moorfields Eye Hospital), of his pioneering work
wrote “every eye could be made luminous if the axis from a
source of illumination directed towards a person’s eye and the
line of vision of the observer were coincident”.
 Although some credit the invention of the ophthalmoscope to
Charles Babbage in 1847, it was not until it was independently
reinvented by Hermann Von Helmholtz in 1851 that its
usefulness was recognized-it was to revolutionize
ophthalmology.
 While training in France, Andreas Anagnostakis, MD, an
ophthalmologist from Greece, came up with the idea of making
the instrument hand-held by adding a concave mirror. Austin
Barnett created a model for Anagnostakis, which he used in his
practice and subsequently when presented at the first
Ophthalmological Conference in Brussels in 1857, the
instrument became very popular among ophthalmologists.
 In 1915, Francis A. Welch and William Noah Allyn invented the
world’s first hand-held direct illuminating ophthalmoscope,
precursor to the device now used by clinicians around the
world. This refinement and updating of Von Helmholtz’s
invention enable ophthalmoscopy to become one of the most
ubiquitous medical screening techniques in the world today.

5. PREPARATION
 Indirect ophthalmoscopy and slit-lamp
ophthalmoscopysss are often performed
after eye drops at placed to widen (dilate)
the pupils. Direct ophthalmoscopy and slit-
lamp ophthalmoscopy can be performed
with or without the pupils dilated.
 Before the test is done, the ophthalmologist
is expected his/her patient
 The following questions
 If he or she is allergic to any drugs
 If he or she is under any medication
 If there is any history of glaucoma.

6. TYPES OF OPHTHALMOSCOPY
 DIRECT OPHTHALMOSCOPY
 INDIRECT OTHALMOSCOPY

7. DIRECT OPHTHALMOSCOPY
 One that produces an upright, or
unreversed, image of approximately 15
times magnification. The patient will be
seated in a darkened room. The
ophthalmologist performs this
examination by shining a beam of light
through the pupils using an instrument
called an ophthalmoscope. An
ophthalmoscope is about the size of a
flash light. It has light and different tinny
lenses that allow the ophthalmologist to
view the back of the eye ball.

8. DIRECT OPHTHALMOSCOPY

9. INDIRECT OPTHALMOSCOPY
 One that produces an inverted, or reversed,
image of 2 to 5 times magnification. The
patient will either lie or sit in a semi-reclined
position. The ophthalmologist holds the eyes
open while shinning a very bright light into
the eye using a binocular indirect
ophthalmoscope worn on the head. The
ophthalmologist views the back of the eye
through a lens held close to the eye. Some
pressure may be applied to the eye using a
small, blunt probe. The patient may be
asked to look in various directions. This
examination is usually used to look for
detached retina.

10. INDIRECT OPTHALMOSCOPY

11. ANOTHER TYPE OF
OPHTHALMOSCOPY
 SLIT-LAMP OPHTHALMOSCOPY: The
patient will sit in a chair with the instrument
placed in front of him/her. The patient will
be asked to rest his/her chin and forehead
on a support to keep the head steady. The
ophthalmologist will use the microscope
part of the slit lamp and a tiny lens placed
close to the front of the eye. The
ophthalmologist can see about the same
with this technique as with indirect
ophthalmoscopy, but with higher
magnification.

12. SLIT-LAMP OPHTHALMOSCOPY

13. TYPES OF OPHTHALMOSCOPE
 The direct ophthalmoscope is an
instrument about the size of a small
flashlight (torch) with several lenses that
can magnify up to about 15 times. This
type of ophthalmoscope is most commonly
used during routine physical examination.
The pan-ophthalmoscope has a larger
primary lens with a variable focusing,
allowing for a wider field-of-view.

14. DIRECT OPHTHALMOSCOPE

15. INDIRECT OPHTHALMOSCOPE
 An indirect ophthalmoscope, on the other
hand, constitutes a light attached to a
headband, in addition to a small handheld
lens. It provides a wider view of the inside
of the eye. Furthermore, it allows a better
view of the fundus of the eye, even if the
lens is clouded by cataracts. An indirect
ophthalmoscope can be either monocular
or binocular. It is used for peripheral
viewing of the retina.

16. INDIRECT OPHTHALMOSCOPE

17. SLIT-LAMP OPHTHALMOSCOPE

18. DILATION OF THE PUPIL
 To allow for better inspection through the
pupil, which constricts because of light from
the ophthalmoscope, it is often desirable to
dilate the pupil by application of a mydriatic
agent, for instance tropicamide, or simply
reducing the brightness of the
ophthalmoscope, which may slightly increase
natural mydriasis, allowing a better view of
the posterior eye. It is primarily considered
ophthalmologist or optometrist equipment,
but is used by other specialists as well,
including neurology and internal medicine.
Recent developments like scanning laser
ophthalmoscopy can make good quality
images through pupils as small as 2
millimeters, so dilating pupils is no longer
needed with these devices.

19. EFFECT OF OPHTHALMOSCOPY
 The bright light will be uncomfortable, but
the test is not painful. Patient may briefly see
images after the light shines in his/her eyes.
The bright light is brighter with indirect
ophthalmoscopy, so the sensation of seeing
after-images may be greater.
 Pressure on the eyes during indirect
ophthalmoscopy may be slightly
uncomfortable, but it should not be painful. If
eye drops are used, they may sting briefly
when placed in the eyes. Patient may also
have an unusual taste in his/her mouth.

20. WHY THE TEST IS PERFORMED
 Ophthalmoscopy is done as part of a
routine physical or complete eye
examination. It is used to detect and
evaluate symptoms of retinal detachment
or eye diseases such as glaucoma.
 Ophthalmoscopy may also be done if a
patient has signs and symptoms of high
blood pressure, diabetes, or other diseases
that affects the blood vessels.

21.  NORMAL RESULT
 The retina, blood vessels, and the optic disc
appear normal.
 WHAT ABNORMAL RESULT MEANS
 Abnormal results may be seen on
ophthalmoscopy with any of the following
conditions:
1. Viral inflammation of the retina (CMV
retinitis)
2. Diabetes
3. Glaucoma
4. High blood pressure
5. Loss of sharp vision due to age-related
macular degeneration
6. Melanoma of the eye
7. Optic nerve problem

22.  Ophthalmoscopy is considered to be
90% to 95% accurate. It can detect the
early stages and effects of many serious
diseases. For conditions that cannot be
detected by ophthalmoscopy, there are
other techniques that may be helpful.

23. RISK
 The test itself involves no risk. In rare
cases, the dilating eye drops causes:
 An attack of narrow-angle glaucoma
 Dizziness
 Dryness of the mouth
 Flushing
 Nausea and vomiting

24. SUMMARY
 Ophthalmoscopy is done as part of a routine physical or
complete eye examination, mainly done by optometrists or
ophthalmologists. It is used to detect and evaluate
symptoms of various retinal vascular diseases or eye
diseases such as glaucoma. In patients with headaches, the
finding of swollen optic discs or papilledema, on
ophthalmoscopy is a key sign, as this indicates raised
intracranial pressure (which could be due to hydrocephalus,
benign intracranial hypertension also known as pseudotumor
cerebri, or brain tumor, amongst other conditions).
 Cupped optic disc are seen in glaucoma. In patients with
diabetes mellitus, regular ophthalmoscopic eye examination
(once every 6 months to 1 year) are important to screen for
diabetic retinopathy as visual loss due to diabetes can be
prevented by retinal laser treatment if retinopathy is spotted
early. In arterial hypertension, hypertensive changes of the
retina closely mimic those in the brain and may predict
cerebrovascular accidents (strokes).

25. REFERENCES
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 “principles of ophthalmoscopy”
(http://www.lifehugger.com/doc/617/Principles_of_Ophthalmoscopy
) . lifehugger.com. Retrieved 2009-05-24.
 Hoovers Citation (http://www.hoovers.com/welch-allyn,-inc./-
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 Allyn, Welch. “PanOptic
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Retrieved 2019-01-29.
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(http://unabridged.merriam-webster.com/medical/). Merriam-
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 Elsevier, Dorland’s Illustrated Medical Dictionary
(http://dorlands.com/) , Elsevier.
 Houston Miffiin Harcourt, The American Heritage Dictionary of the
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