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Dr. Mamta Dept of Ophthalmology RNT Medical College, Udaipur
Dr. Mamta Dept of Ophthalmology RNT Medical College, Udaipur
Dr. Mamta Dept of Ophthalmology RNT Medical College, Udaipur
MAMTA
Dept of ophthalmology
RNT Medical college, Udaipur
Ophthalmoscopy is a clinical examination of
the interior of the eye by means of an
ophthalmoscope.
It is primarily done to assess the state of
fundus and detect the opacities of ocular
media.
The ophthalmoscope was invented by von
Helmholtz in 1850.
temporal
nasal
DISC: LOCATION –nasal to geometric axis
Corrective lens is
placed along pathway Convergent Divergent
light, if subject light, if subject
myopic hypermetropic
The image is erect, virtual and about 15 times
magnified in emmetropes.
Technique- should be performed in a semi-
darkroom with the patient seated and looking
straight ahead , while the observer standing
or seated slightly over to the side of the eye
to be examined by the observer with his or
her right eye and left with the left.
The observer should reflect beam of light
from the ophthalmoscope into patients pupil.
Once the red reflex is seen the observer
should move as close to the patients eye as
possible.
Once the retina is focused the details should
be examined systematically starting from
disc,blood vessels, the four quadrant of the
general background and the macula.
Monocular Indirect Ophthalmoscopy
It consists of-
Illumination rheostat at its base,
Focusing lever for image refinement,
Filter dial with red free and yellow filters,
Forehead rest for proper observer head
positioning, and
Iris diaphragm lever to adjust the illumination
beam diameter.
Optics- an internal relay lens system re-
inverts the initially inverted image to a real
erect one, which is then magnified. This
image is focusable using the focusing lever.
Indications are-
Need for an increased field of view
Small pupils
Uncooperative children
Patients intolerance of bright light of
binocular indirect ophthalmoscope.
Extent of view- although vitreous base views
are possible with monocular IO, its greatest
effectiveness extends anteriorly to the
peripheral equatorial region.
Advantage- field of view similar to IO and,
Erect real image similar to DO.
Disadvantage –are lack of stereopsis,
Limited illumination and,
Fixed magnification.
It is very popular method for examination of
posterior segment introduced by Nagel in
1864.
PRINCIPLE- To make the eye highly myopic by
placing a strong convex lens in front of
patients eye so that the emergent rays from
an area of the fundus are brought to the
focus as a real,inverted image between the
lens and the observers eye.
An inverted reverse real image
Magnification = 2 to 4 X
Field of view = 40 to 50 degrees
Optimal working distance = 40 to 50 cms
Good illumination & stereopsis
Ease of use with scleral indentor
Lenses from 14 to 30 D range
CHARACTERISTICS- Magnification of image
depends upon the dioptric power of convex
lens, position of the lens in relation of the
eyeball and refractive state of eyeball.
About 5 times magnification is obtained with
+13 D lens.
With a stronger lens,image will be smaller,
but brighter and field of vision will be more.
(1) Dark room
(2) source of light and concave mirror or self
illuminated indirect ophthalmoscope
(3) Convex lens
(4) pupils of the patient should be dilated.
The patient is made to lie in the supine
position, with one pillow on a bed or couch
and instructed to keep both eyes open.
The examiner throws the light into patients
eye from an arms distance.
In practise, Binocular ophthalmoscope with
head band or that mounted on the spectacle
frame is employed most frequently.
Keeping his or her eyes on the reflex, the
examiner then interposes the condensing
lens in the path of beam of light, close to the
patient eye, and then slowly moves the lens
away from eye until the image of retina is
clearly seen.
The examiner moves around the head of the
patient to examine different quadrants of the
fundus.
He or she has to stand opposite to clock hour
position to be examined.
By asking the patient to look in extreme gaze,
and using of scleral indenter, the whole
peripheral retina up to ora serrata can be
examined.
Scleral indentation- helps in making prominent
the barely perceptible lesions, done with the
depressor placed on patients lid.
Examiner should move the scleral depressor in a
direction opposite to that in which he or she
wishes the depression to appear.
Scleral depressor should be rolled gently and
tangentially over the eye surface.
The temporal part of upper lid is sufficiently lax
so depressor can be placed inferiorly in the
horizontal meridian.
-Thimble scleral
depressor
• Delivery of LASER
• Increased illumination
• Reduced distortion
Background/periphery Vitreous
Pigmentation changes Asteroid hyalosis, floater
in retinitis pigmentosa haemorrhages
Retinal tears,
detachments
Retinal nerve fibre layer
Dropout in glaucoma,
myelination at disc margi
Vessels Fovea
Haemorrhages ARMD, drusen,
Optic disc
in diabetes, macular holes
vessel occlusion, Myopic crescent
hypertension in myopia
Crossings: nipping in Cupping and notching
systemic hypertension in glaucoma
Bifurcations: embolisms, Anterior ischaemic opti
branch occlusions neuropathy in diabetes
Vessel walls: sheathing in Swelling and blurred
systemic hypertension, leakage margins in papilloedem
and neovascularisation in diabetes. and optic neuritis
(1) Hruby lens biomicroscopy
(2) Contact lens biomicroscopy
(3) Indirect fundus biomicroscopy
Hruby lens is a planoconcave lens with
diopteric power 58.6D, which neutralizes the
optical power of normal eye (60D) and forms
a virtual,erect image of the fundus.
This lens provides a small field with low
magnification and cannot visualize the
fundus beyond equator.
It combines stereopsis, high illumination and
high magnification with the advantages of slit
beam.
Modified Koeppe lens, i.e. posterior fundus
contact lens can be used to examine the
posterior segment, provides a virtual and
erect image.
Goldmanns three-mirror contact lens, consist
of a central contact lens and three mirror
placed in the cone,each with different angles
of inclination.
With this, the central as well as peripheral parts
of the fundus can be visualized.
It also provides a virtual and erect image.
By flat central portion can see posterior
vitreous and pole.