Fundoscopy

Question 1

What are the steps?

Answer 1

Introduction, Identification, Explanation and Consent

Preparation

Examination - red reflex, fundoscopy, fundus

Question 2

Preparation

Answer 2

1. Patients pupils should, ideally be dilated either by:
   - Examining in a dark room
   - Instilling drops to dilate pupils (postgrad only)
2. Ensure you and the patient are in a comfortable position
3. Patient to fix haze on a small named distant object
4. Use your right eye and right hand to examine patient’s right eye, and your left eye and left hand for patients left eye

Question 3

Red Reflex

Answer 3

Switch on and select lens ‘0’, hold ophthalmoscope vertically in your hand, brow-piece touching your eyebrow

Direct beam of light into pupil from a distance of approx 30cms

Presence of the red reflex demonstrates that light is entering the eye and being reflected back from the fundus; absence indicates obstruction to light pathway e.g. cataract

The red eye reflex can be done for both eyes at this stage, before moving onto fundoscopy

Question 4

Fundoscopy

To examine patient’s right eye

Answer 4

• Sit/stand a little to the right of the patient (approx 15 degrees from midline), allowing patient a clear view of a distant named object over your right shoulder
• Ask the patient to try to keep looking at the object, in order to keep the eyes still
• Hold ophthalmoscope vertically in your right hand, brow-piece touching your eyebrow, right index finger placed, semi-flexed, on lens dial
• Select “0” on lens dial

Question 5

Fundoscopy

To examine patient’s left eye

Answer 5

• Same as right eye, but sitting/standing a little to the left of the patient, using your left eye and left hand to view the fundus
• hold scope vertically in your left hand, brow-piece touching your eyebrow, left index finger placed, semi-flexed, on lens dial
• Select “0” on lens dial

Question 6

Examine Fundus

Focussing on the Fundus

Answer 6

Move nearer the patient so that the ophthalmoscope is at a distance of approx 2-4cms from the patient’s eye - This will usually be when the knuckles of the hand holding the ophthalmoscope touch the patient’s cheek

Ensure your eye and patient’s eye are on the same horizontal level

Always hold the ophthalmoscope with your index finger semi-flexed on t the lens dial to make lens adjustment easier

Adjust lenses to obtain a sharp image of the fundus - Starting with lens ‘0’ focus on the disc or a blood vessel, if blurred increase or decrease

Question 7

Examine Fundus

What are you commenting on for the fundus?

Answer 7

Optic disc

Vessels

Retina

Macula

Question 8

What do you comment on for the optic disc?

Answer 8

• Shape
• Colour
• Definition of edges
• Note appearance of vessels as they cross rim

Question 9

What do you comment on for the vessels?

Answer 9

Note appearance of arteries, veins - tortuous, congested, arteriovenous nipping

Question 10

What do you comment on for the Retina?

Answer 10

• Colour
• Haemorrhages
• Exudates
• Detachment
• Tears

Question 11

Macula

Answer 11

Ask patient to look directly at the beam of light just before finishing looking at that eye