Funduscopic exam is a routine part of every doctor’s examination of the eye, not just the ophthalmologist’s. It consists exclusively of inspection. One looks through the ophthalmoscope , which is simply a light with various optical modifications, including lenses. The ophthalmoscope illuminates the retina through the normal iris defect that is the pupil. Light rays forming the image of the retina re-emerge through the pupil. The viewing aperture (window) of the ophthalmoscope contains a lens that modifies light rays to assist the user. In the procedure, one looks at structures lying in the innermost aspect of the globe, collectively known as the eyegrounds: retina, retinal blood vessels, optic nerve head (disk), and to a limited degree, subjacent choroid.
- Keep both yours and the person’s eyes
- Have the patient focus on a distant object
- Look at right fundus with your right eye
- Ophthalmoscope should be close to your eyes. Your head and the scope should move together
- Set the lens opening at +8 to +10 diopters. With the ophthalmoscope 12-15 inches from the patient’s eye, check for the red reflex and for opacities in lens or aqueous.
- While adjusting the diopter setting, approach the patient more closely and systematically inspect the disc, noting the color, shape, margins and cup-to-disc ratio.
- Inspect the vessels, noting obstruction, caliber and arterial/venous ratio.
- Note the presence of arterial/venous nicking and arterial light reflex.
- Check the background by inspecting for pigmentation, hemorrhages and hard or soft exudates.
- Next, try to identify the macula (Have the patient look at light)
Author: A. Chandrasekhar, MD
References for Funduscopic examination:
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