Direct Ophthalmoscopy

Significance filters notes

Posterior eye Red-free filter: retinal vessels Opacities:
Lesions: 1. Anterior: move opposite
Determine: presence 1. Retinal are black to light
or absence of 2. Choroidal are grey 2. Close to lens nucleus:
pathology little to no movement
Slit aperture: elevation or depression of lesion 3. Posterior lens or vitreous:
same direction
Polarizing filer & Half circle aperture: decrease corneal a. Vitreous: float back
reflections

Microspot aperture: undilated pupils

Small aperture: start w this

Large aperture: dilated pupil

Fixation aperture: see eccentric fixation (no macula

masking)
recording

Advantages Disadvantages Most common errors vessels

1. Image: erect, 1. Lack illumination 1. Not close enough to pt Veins
magnified, well- 2. Lack of stereopsis esp when trying to § Larger & darker
detailed, real image of 3. Close working distance view macula § Don’t reflect light
retina 2. Using cup pallor § More tortuous paths
2. Easiest to master instead of deflection of § Veinous pulse
3. Provides: great pt 4. Dependence on BV as a determinant of § Visible: main veinous
comfort refractive errors for cupping’s edge trunks
4. Can be used: smaller clarity & magnification 3. Not having pt view in
pupils 5. Small field of view diff directions of gaze Arteries
5. Most accurate: to get better view of § Thinner, lighter or
estimate of pt visual non-central retina brighter red and
compromise bc media straighter
opacification § Arterial reflex
6. 10-12 degree field of § No pulse
view § Cilio-retinal arteries:
7. Magnification: 15x small vessels curving
8. Small part of fundus: to macula
moderate to high
Arterial pulsation:
magnification
pathological
Copper wire arteries:
thickened walls; broader-
reddish orange reflex
Silver wire arteries:
advanced AS: reflex pale