Ophthalmoscopy (funduscopy or fundoscopy) is a test that allows a health professional to see inside the fundus of the eye and

other structures using an ophthalmoscope (or funduscope). It is done as part of an eye examination and may be done as part of a routine physical examination. It is crucial in determining the health of the retina and the vitreous humor. An alternative or complement to ophthalmoscopy is to perform a fundus photography, where the image can be analysed later by a professional.
Contents [hide] 1 Types 2 Indications 3 Dilation of the pupil 4 History 5 See also 6 References 7 External links

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Types
It is of two major types: Direct ophthalmoscopy one that produces an upright, or unreversed, image of approximately 15 times magnification. Indirect ophthalmoscopy one that produces an inverted, or reversed, direct image of 2 to 5 times magnification. Features Direct ophthalmoscopy Indirect ophthalmoscopy Not Required Required Condensing lens As close to patient's At an arm's length Examination distance eye as possible Virtual, erect Real, inverted Image Not so bright; so not Bright; so useful for Illumination useful in hazy media hazy media About 2 disc diameters About 8 disc diameters Area of field in focus Absent Present Stereopsis Slightly beyond Up to Ora serrata i.e. Accessible fundus view equator peripheral retina Examination through Not possible Possible hazy media Each type of ophthalmoscopy has a special type of ophthalmoscope: The direct ophthalmoscope is an instrument about the size of a small flashlight (torch) with several lenses that can magnify up to about 15 times. This type of

ophthalmoscope is most commonly used during a routine physical examination.

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An indirect ophthalmoscope, on the other hand, constitutes a light attached to a headband, in addition to a small handheld lens. It provides a wider view of the inside of the eye. Furthermore, it allows a better view of the fundus of the eye, even if the lens is clouded by cataracts.[1] An indirect ophthalmoscope can be either monocular or binocular. It is used for peripheral viewing of the retina. [edit]

Indications
This section does not cite any references or sources. (September 2012)

Ophthalmoscopy is done as part of a routine physical or complete eye examination. It is used to detect and evaluate symptoms of retinal detachment or eye diseases such as glaucoma. In patients with headaches, the finding of swollen optic discs, or papilledema, on ophthalmoscopy is a key sign, as this indicates raised intracranial pressure (ICP) which could be due to hydrocephalus, benign intracranial hypertension (aka pseudotumor cerebri) or brain tumor, amongst other conditions. Cupped optic discs are seen in glaucoma. In patients with diabetes mellitus, regular ophthalmoscopic eye examinations (once every 6 months to 1 year) are important to screen for diabetic retinopathy as visual loss due to diabetes can be prevented by retinal laser treatment if retinopathy is spotted early. In arterial hypertension, hypertensive changes of the retina closely mimic those in the brain, and may predict cerebrovascular accidents (strokes). [edit]

Dilation of the pupil

To allow for better inspection through the pupil, which constricts because of light from the ophthalmoscope, it is often desirable to dilate the pupil by application of a mydriatic agent, for instance tropicamide. It is primarily considered ophthalmologist equipment. Recent developments like Scanning Laser Opthalmoscope can make good quality images though pupils as small as 2 millimeters, so dilating pupils is no longer needed with these devices. [edit]

Slit Lamp Examination

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The slit lamp exam uses an instrument that provides a magnified, threedimensional (3-D) view of the different parts of the eye. During the exam, your doctor can look at the front parts of the eye, including the clear, outer covering (cornea), the lens, the colored part (iris), and the front section of the gel-like fluid (vitreous gel) that fills the large space in the middle of the eye. Special lenses can be placed between the slit lamp and the cornea (or directly on the cornea) to view deeper structures of the eye, such as the optic nerve, retina, and the area where fluid drains out of the eye (drainage angle ). A camera may be attached to the slit lamp to take photographs of different parts of the eye. See a picture of the structures of the eye . Fluorescein dye eyedrops may be used during a slit lamp examination to make it easier to detect a foreign body, such as a metal fragment, or an infected or injured area on the cornea. Why It Is Done A slit lamp exam may be done: As part of a routine eye exam along with other procedures to evaluate the eye, such as ophthalmoscopy, vision testing, or tonometry (to measure pressure in the eye). To look at structures in the back of the eye, such as the optic nerve or retina. To help detect disorders in the structures in the front of the eye, such as infection or injury to the cornea, cataracts, conjunctivitis, or iritis. To help detect and monitor glaucoma or macular degeneration. To check for a foreign body, such as a metal fragment, on or in the eye. To detect eye problems that may be caused by other diseases, such as diabetes or rheumatoid arthritis. Routine slit lamp exams are important to detect eye problems at an early stage and to guide treatment if eye problems develop. To monitor complications such as bleeding after an eye injury.

To monitor complications such as cataract formation that occur because of chemotherapy, radiation treatment, or after a bone marrow transplant. How To Prepare If you wear glasses or contact lenses, you will need to remove them before the slit lamp examination. Eyedrops may be used to widen (dilate) your pupils and to numb the surface of your eyes. Before the test, tell your doctor if you have glaucoma or are allergic to dilating or anesthetic eyedrops. If dilating drops are used, your eyes may be sensitive to light and you will have trouble focusing your eyes for several hours. If you know your eyes will be dilated, you may wish to arrange for someone to drive you home after the test. You also will need to wear sunglasses when you go outside or into a brightly lit room. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form.

Eye Pain Causes

Causes of eye pain fall into two broad categories: ocular pain and orbital pain. Ocular pain is eye pain coming from the outer structures of the surface of the eye. Conjunctivitis is one of the most common eye problems. Conjunctivitis can be an allergic, bacterial, chemical, or viral inflammation of the conjunctiva (the delicate membrane lining the eyelid and covering the eyeball). Pinkeye is a nonmedical term usually referring to a viral conjunctivitis, because the conjunctiva gets inflamed and turns a pinkish color. Pain is usually mild, or there is no pain at all. Itching, redness, and drainage are typical symptoms associated with conjunctivitis. Corneal abrasions and corneal ulcerations are also common causes of eye pain. The cornea is the transparent surface of the eye. Abrasions

occur from scratches to the surface of the cornea, such as from a foreign body in the eye or overuse of contact lenses. Ulcerations occur from infections or abrasions. Foreign bodies, usually located on the cornea or in the conjunctiva, are objects or materials that give you the sensation that something is in your eye. Foreign bodies produce eye pain similar to that of corneal abrasions. Chemical burns and flash burns are significant causes of eye pain. Chemical burns come from eye exposure to acid or alkaline substances, such as household cleaners or bleach. Flash burns occur from intense light sources, such as arc welding or tanning booths, when improper eye protection is worn. Even an intense sunny day can cause a flash burn. Blepharitis causes eye pain when an inflammation of the eyelid is caused by plugged oil glands at the eyelid edges. A sty or a chalazion causes eye pain because of local irritation. Both cause a lump you can see or feel within the eyelid formed by a blocked oil gland. This lump causes irritation to the eye, can be very painful to the touch, and is seen in both children and adults. Orbital pain is described as a deep, dull ache behind or in the eye. This pain is often caused by diseases of the eye. Glaucoma can cause orbital pain, although most cases of glaucoma are painless. Glaucoma is caused by an increase in intraocular pressure, or internal eye pressure, which can ultimately lead to defects in vision and even blindness if left untreated. Intraocular pressure can increase because of a blockage of outflow or increased production of aqueous humor (the fluid that bathes the inner eye). This is typically seen in older adults. Iritis is an inflammation of the iris, or colored part of the eye, that causes deep eye pain. Optic neuritis is an inflammation of the optic nerve. The optic nerve connects to the back of the eye. The cause of this inflammation can be from multiple sclerosis, viral infections, or bacterial infections and can cause symptoms such as pressure behind the

eye along with visual changes and eye pain. Sinusitis, which is a bacterial or viral infection of the sinuses, can cause a sensation of orbital or eye socket pain. Migraines are a very common cause of orbital eye pain associated with headaches. Traumatic events, such as a penetrating injury to the eye, a blow to the eye with a foreign object, and motor vehicle collisions, are causes of significant eye pain and injury. Scratches to the cornea typically associated with traumatic events are very painful. These are a common eye problem that leads people to seek medical attention.

Eye Pain Symptoms

Pain is a variable measure. Each person may interpret pain differently. Eye pain and other symptoms often described by those experiencing eye problems are summarized below: Pain in or around the eye Partial or complete loss of vision Extreme light sensitivity Double vision Halos (colored circles or halos around lights) New floaters (spots, strings, cobwebs, or shadows seen before the eyes)

Limitation of normal eye movement Pain with movement of the eye in different directions Sensation of flashes or streaks of light Severe headache associated with eye pain Your doctor or an ophthalmologist may see these signs as evidence of eye problems: Redness of the white of the eye (conjunctiva) Redness that flares out and surrounds the colored part of the eye (iris) Irregularly shaped pupil Bulging or protrusion of the eye Swelling or redness of the surrounding eye tissue, including the eyelids Blood or pus inside the front of the eye (within the colored part of the eye) Eye discharge, excessive tearing, crusting, or eyelids stuck together (especially upon awakening) A scratch to the cornea or eyeball

Eye Foreign Body Symptoms

Sharp pain in the eye followed by burning, irritation, tearing, and redness Feeling that something is in the eye when moving the eye around while it is closed

Scratching sensation over the eye when blinking Blurred vision or vision loss in the affected eye Bleeding into the white part of the eye, which can be either a conjunctival hemorrhage or a subconjunctival hemorrhage. (Sometimes, this is associated with a penetrating injury.) Blood layering in front of your iris, the colored area of the eye, and behind the cornea, the clear dome on the front of the eye (This is called hyphema and is often a sign of significant injury.)
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