Basics of

Optic fundus
Exam
Norwin A. Detalla, MD

Objectives
Describe Patient preparation Demonstrate correct procedure using the ophthalmoscope Describe the normal fundus Describe abnormal findings, and recognize disease process

Direct Ophthalmoscope
Brow Rest
Viewing aperture Beam Selector Peephole
Lens wheel

Lens power

Rheostat

Handle

Normal Ocular Fundus

Arterioles

Optic cup Fovea Optic disc Vein

Normal fundus

Disc: Clear outline; optic cup is pale and centrally located.

Normal fundus

Disc: Clear outline; optic cup is pale and centrally located.

Retina: Normal red/orange colour, macula is dark. The macula is approximately 2 disc diameters away from disc and 1.5 degrees below horizon.

Normal fundus

Disc: Clear outline; optic cup is pale and centrally located.

Retina: Normal red/orange colour, macula is dark. The macula is approximately 2 disc diameters away from disc and 1.5 degrees below horizon.

Vessels: Arterial/venous ratio 2 to 3; the arteries appear a bright red, the veins a slightly purplish colour.

Optic nerve
Consists of 1 million axons that arise from the retina. Leaves the eye through the sclera optic canal into the cranium.

What to observe
Optic disc- colour/size/edges Cup size Blood vessels number/width/tortuosity Macular / fovea Other findings hemorrhages, soft and hard exudates, edema

Procedure

Ask patient to fix stare at far object Turn on scope and set dial to 0 Remember right eye right hand Rest hand on patients forehead Begin at arms length away, should see red reflex. Move closer until optic disc visible ( approx. 35cms) Turn dial until disc in focus. Hyperopic turn disc for plus numbers (green) Myopic minus numbers (red)

Micro Spot Aperture: Allows quick visual entry in very small, undilated pupil Small Aperture: Provides easier view of fundus through undilated pupil

Large Aperture: Standard aperture for dilated pupil and general examination of the eye Fixation Aperture: Features graduated cross-hairs for measuring eccentric fixation or for locating lesions and other abnormalities Slit: Used to determine various levels of lesions and tumors

Cobalt Filter: Blue filter used with Fluorescein dye permits easy viewing of small lesions, abrasions and foreign objects on the corneal surface

Red Free Filter: Green filter used to study blood vessels and retinal nerve fiber layer (RNFL)

Flame-shaped hemorrhage

Microaneurysm / dot blot hemorrhage

Exudates

Macular edema

Cotton-wool spot

Vitreous hemorrhage

Neovascularization

Hypertensive Retinopathy
Modified Scheie Classification Grade 0: No changes Grade 1: Minimal arteriolar narrowing Grade 2: Obvious arteriolar narrowing with focal irregularities Grade 3: Grade 2 + retinal hemorrhages and/or exudate Grade 4: Grade 3 + swollen optic nerve (Malignant hypertension)

Hypertensive Retinopathy Grade 2

Arteriovenous nicking in association with hypertension Grade 2 (black arrows)

Hypertensive Retinopathy Grade 3

Flame-shaped hemorrhage in association with severe hypertension Grade 3 (red arrow)

Hypertensive Retinopathy Grade 4

Papilledema from malignant hypertension. There is blurring of the borders of the optic disk with hemorrhages (red arrows) and exudates (white arrow)