DIRECT

OPTHALMOSCOPY
BY SONI PRASAD
AMITY MEDICAL SCHOOL HARYANA
MOCO (3RD SEM )

HISTORY
The first ophthalmoscope, invented by
BABBAGE in 1847
In 1851,HELMHOLTZ developed the first
ophthalmoscope to receive the attention of
the medical profession

TERMINOLOGY

DIRECT: -going from one place to another

without changing direction.
OPHTHAL: -eye
SCOPE: -referring to an instrument for
observing or examining.

It is an instrument for observing / examining

the eye without changing direction.

Alternate Names: Fundoscopy

DEFINITION

Ophthalmoscopy is an examination of
the posterior part of the eyeball
(fundus), which includes the retina,
optic disc, Choroid, and blood vessels.
As well as allowing a view of the
anterior segment in general diffuses
illumination

PRINCIPLE

Light is directed by the prism through the

patients pupil and illuminates the ocular
fundus. The illuminated area of the retina
becomes the object for the correcting lens
to image. The observer selects a lens power
to focus the area of interest. The image is
upright and virtual

On/Off Rheostat

View aperture / Lens power indicator

Pupil size: large / smallAuxiliary controls:

Red-free filter, Fixation target, and Slit beam

PROCEDURE

We use OD on Patients OD and OS on Patients OS

Corrections not used unless very high refractive
errors or Astigmatism presentInitially
set power at +8 to +12 Diopters.
Find red reflex of fundus
Move in/out to focus on cornea and lens structures
Look for opacities in media: scars, dots,
cataractsParallax movement -- retro illumination
Reduce plus to move into vitreous Look for
opacities in media: floaters Change positions and
focus as power is reduced slowly

Reduce plus to focus on fundus

-- Knuckles should touch cheek of Patients to
stabilize
-- Look for arteries or veins
-- Bifurcations point direction to disc
-- Expect OHN to be seen when we are about 15
degrees temporal
.From OHN follow course of arteries and veins
-- Follow each bifurcation
-- Look between vessels
--- Change Patients gaze to view different quadrants

LIMITATION
No stereopsis is possible since one can only
obtain a monocular view.
Secondly, only the posterior, central fundus
can be visualized, and the majority of the
peripheral fundus cannot be seen.
Therefore, if a retinal tear or detachment is
suspected, or if there is a significant risk of
retinoblastoma, or histoplasmosis, other
techniques must be used

ADVANTAGE
Direct ophthalmoscopy can be used for
close evaluation of fundic lesions
Usefull to see central area of the retina,for
quick examination

DISADVANTAGES

In viewing the fundus, only small areas can be seen

at any one time. Complicated by ocular movement
during examination-- our patients can be restrained
physically, but not their eyeball movements.
To view the eye, must bring instrument and your
face very close (2 - 3 cm) to patient's eye. In
temperamental animals, this may pose problems.
It is harder to visualize the fundus through cloudy
ocular media.
It is more difficult to examine the peripheral fundus.
Stereopsis is absent.