1 / 33

Direct Ophthalmoscopy

Direct Ophthalmoscopy. “THE EYE IS A WINDOW TO SYSTEMIC DISEASE”. Sandra Tubito, O.D. July 2007. Discussion Outline. Why ophthalmoscopy? Types of ophthomoscopy Direct ophthalmoscope Examination Procedure Setting External Exam Internal Exam What you should see Pathology Questions.

woutten
Download Presentation

Direct Ophthalmoscopy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DirectOphthalmoscopy “THE EYE IS A WINDOW TO SYSTEMIC DISEASE” Sandra Tubito, O.D. July 2007

  2. Discussion Outline • Why ophthalmoscopy? • Types of ophthomoscopy • Direct ophthalmoscope • Examination Procedure • Setting • External Exam • Internal Exam • What you should see • Pathology • Questions

  3. Why ophthalmoscopy? • Only way (and place in the body) that veins and arteries can be seen in their natural state, non-invasively. • Part of general optical screening where direct observation of the structures of the fundus may show: • Disease of the eye itself (e.g. glaucoma, retinal detachment) • Abnormalities indicative of disease elsewhere in the body (e.g. diabetes, hypertension) • Evaluation of ocular complaints

  4. Types of Ophthalmoscopes Direct ophthalmoscope Indirect ophthalmoscope

  5. Direct X15 magnification 10° field of view Real image Monocular Undilated pupil Maximum resolution of 70µm Indirect X2-3 magnification 30° field of view Inverted and upside down image Binocular Dilated pupil Maximum resolution of 200µm Types of Ophthalmoscopes

  6. Direct Ophthalmoscope • Illuminating system • Light bulb • Lenses • Reflector • Aperture stops and filters • Different sized stops to change illumination of the retina • Green (red free) filter • Viewing system • Sight hole (3mm in diameter) • Focusing lenses

  7. Direct Ophthalmoscope

  8. Examination Procedure • Setting • Dark room • Seat patient in comfortable chair with head rest • Ask patient to look at a slightly elevated target on opposite wall

  9. Examination Procedure • External Exam • Look at R eye with R eye (L with L) • Place hand on shoulder or forehead • Change viewing angle to 15° to avoid light reflex of cornea

  10. Examination Procedure • External Exam • Red Reflex - hold ophthalmoscope at ~50cm and look through sight hole at the ocular media. Find the red reflex in the pupil. Opacities (eg cataracts) can be seen. • Place +8.00D lens in sight hole and move to ~10cm to inspect anterior structures: • lids/lashes • conjunctiva • cornea

  11. Examination Procedure • Internal Exam • Turn focus wheel to bring anterior chamber and iris into focus • Gradually reduce power in ophthalmoscope to focus on internal structures: • Lens • Vitreous • Retina

  12. Examination Procedure • Internal Exam • Continue turning focus wheel to bring retina/vessels in focus • Follow the vessels to the disc • The ‘arrow’ point to the disc • Examine the disc, vessels, retina, & macula.

  13. Things you should see • The optic nerve head • Appearance – shape/size (1.5mm in diameter) • Color – disc is pale pink, cup is whitish • Elevation – should be flat • Rim – clear and distinct • Cup/Disc ratio • Ratio of the diameter of the cup to the diameter of the disc

  14. Cup /Disc ratio

  15. Things you should see • Retinal vessels • Arteries • Lighter in color, smaller • Veins • Darker in color, larger • May spontaneously pulsate at the disc (80%) • The ratio of the artery :vein diameter is normally ~ 2:3 • Follow vessels from disc • Look at arterio-venous crossings for abnormalities (nicking, compression, elevation, deviation) • Check arterial light reflex. This will get whiter and thicker in arteriosclerosis

  16. Arteriovenous changes Tapering concealment of the vein appearing as ‘nicking’ Elevation of the vein over the artery Deviation of the vein out of its path Compression of the vein at the arterio-venous crossing, causing stenosis of the distal vein

  17. Things you should see • Retina • Check the background retina • Look for color differences • areas of hyper or hypo pigmentation • Scarring • Raised areas • Hemorrhages, microaneurisms • Cotton wool exudates • Hard exudates • A more peripheral view can be obtained by having the patient look in different directions OD OS

  18. Things you should see • Fovea and Macula • Change sight hole to the smallest aperature • Have patient look at the light • Temporal and slightly inferior to the disc • Slightly darker than rest of retina • Central depression/reflex - fovea

  19. Pathology - The optic nerve Optic atrophy

  20. Pathology - The optic nerve “Choked disc” or Papilledema

  21. Pathology – The optic nerve Glaucomatous cupping

  22. Pathology - The optic nerve Papilledema with papillary hemorrhages Disc neovascularization

  23. Pathology – Retina / Vessels Arterial occlusions

  24. Pathology – Retina / Vessels Circinate exudates

  25. Pathology – Retina / Vessels Intra-retinal hemorrhages

  26. Pathology – Retina / Vessels Cotton wool spots

  27. Pathology – Retina / Vessels Neovascularization

  28. Pathology - Retina / Vessels Arterial plaques

  29. Pathology – Retina / Vessels Venous occlusions

  30. Pathology - Macula Drusen

  31. Pathology - Macula Age related macula degeneration Hemorrhagic phase

  32. Pathology - Macula Exudative age related macular degeration

  33. QUESTIONS?

More Related