EXAMINATION

SYMPTOMS AND SIGNS

MOST OF THE PRESENTING MANIFESTATION
OF THE EYE INVOLVEMENT FALL INTO ONE OF
THE FIVE CATAGORIES
1. SUBNORMAL VISUAL ACUITY
2. PAIN OR DISCOMFORT
3. CHANGE OF APPEARANCE OF LIDS, ORBIT OR
THE EYE
4. DIPLOPIA
5. DISCHARGE OR INCREASE CONJUNGTIVAL
SECRETION
SUBNORMAL VISUAL ACUITY
A. DURATION
- IS THE PATIENT’S VISUAL ACUITY SAME AS
IT HAS BEEN FOR THE MOST OF HIS LIFE ?
- WAS THE CHANGE IN ACUITY RECENTLY
NOTES ?
- WAS IT FOUND BY ACCIDENTALLY
COVERING ONE EYE ?
- HAS THER BEEN A GRADUAL DIMINUTION
OF ACUITY OVER MANY MONTHS OR YEARS ?
B. DIFFERENCE IN VISUAL ACUITY IN
THE TWO
EYES
- IS THE PATIENT CERTAIN THAT VISUAL
ACUITY WAS FORMERLY THE SAME IN BOTH
EYES ?
C. DISTURBANCES OF VISION
1. METAMORPHOSIA
DISTORTION OF THE NORMAL SHAPES OF
OBJECT. DUE TO : - ASTIGMATISM
- MACULAR LESION

2. PHOTOPHOBIA
INCREASE LIGHT SENSITIVITY, DUE TO :
- CORNEAL INFLAMMATION
- APHAKIA
- IRITIS
- OCULAR ALBINISM
- DRUGS, SUCH AS CHLOROQUINE,
ACETAZOLAMIDE
3. CHROMATOPSIA
COLOR CHANGE SUCH AS YELLOW WHITE OR RED
VISION, DUE TO :
- CHORIORETINAL LESION
- LENTICULAR CHANGE
- JAUNDICE

4. HALOS OR RINGS
SEEN WHEN VIEWING LIGHTS OR BRIGHT
OBJECTS, DUE TO :
- GLAUCOMA / CORNEAL OEDEMA
- INCIPIENT CATARACT
5. “SPOTS”
“SPOTS
BEFORE THE EYES, SEEN AS DOTS OR FILAMENTS,
WHICH MOVE WITH MOVEMENT OF THE EYE, DUE
TO BENIGN VITREUS OPACITIES

6. VISUAL FIELD DEFECTS

DUE TO DISORDERS OF :
- CORNEA
- MEDIA
- OPTIC NERVE
- BRAIN
7. NYCTALOPIA / NIGHT BLINDNESS
DIFFICULTY SEEING IN THE DARK
- CONGENITAL, RETINITIS PIGMENTOSA
- ACQUIRED, VITAMIN A DEFICIENCY, GLAUCOMA,
OPTIC ATROPHY, CATARACT, RETINAL DEGENE-
RATION

8. AMAUROSIS FUGAX
MOMENTARY LOSS OF VISION, DUE TO :
- IMPENDING CEREBROVASCULAR ACCIDENT
- SPASM OF THE CENTRAL RETINAL ARTERY
- PARTIAL OCCLUSION OF THE INTERAL CAROTID
ARTERY
 EXAMINATION
SYMPTOMS AND SIGNS
MOST OF THE PRESENTING MANIFESTATION
OF THE EYE INVOLVEMENT FALL INTO ONE OF
THE FIVE CATAGORIES
1. SUBNORMAL VISUAL ACUITY
2. PAIN OR DISCOMFORT
3. CHANGE OF APPEARANCE OF LIDS, ORBIT OR
THE EYE
4. DIPLOPIA
5. DISCHARGE OR INCREASE CONJUNGTIVAL
SECRETION
 PAIN OR DISCOMFORT
THE USUAL PAINFUL SYMPTOMS, MENTIONED
ARE :
- HEADCHE
- EYE-ACHE

ACUTE LOCALIZED PAIN INTENSIFIED BY

MOVEMENT OF THE EYE OR LID SUGGEST :
- FOREIGN BODIES
- CORNEAL ABRASION
HEADCHE THAT OCCURS UPON ARISING IN
THE MORNING AND DISSAPEARS SOON
AFTERWARD IS SELDOM CAUSED BY EYE
DISORDERS, A GENERAL MEDICAL EXAMI-
NATION IS INDICATED

MILD TO MODERATE HEADCHE WHICH OCCUR

TOWARD THE END OF A DAY OF EXACTING
EYE WORK AND WHICH ARE RELIEVED BY A
FEW HOURS OF REST OR SLEEP ARE MORE
PROBABLY DUE TO OCULAR DISORDERS
SEVERE HEADCHE WHICH IS BECOMING
WORSE SHOULD SUGGEST AN INTRACRANIAL
LESION :
- VISUAL FIELD TEST
- OPHTHALMOSCOPY
- NEUROLOGIC INDICATED
CONSULTATION
“EYE-ACHE”
- MUSCLE IMBALANCE
- INFLAMATORY LESIONS INVOLVING
THE
EPISCLERA, IRIS, CHOROID
- INCREASED PRESSURE OF GLAUCOMA
- FEVER, NEURALGIA, RETROBULBAIR
NEURI-
TIS, TEMPORAL NEURITIS
- SEVERE INFLUENZA AND DENGUE
BURNING AND ITCHING
INFLAMATION OF THE LIDS OR CONJUNG-
TIVA, SUCH AS :
- CHRONIC BLEPHARITIS
- CONJUNGTIVITIS
- ALLERGIC REACTIONS
ITCHING IS A SYMPTOM OF OCULAR ALLERGY
 EXAMINATION
SYMPTOMS AND SIGNS
MOST OF THE PRESENTING MANIFESTATION
OF THE EYE INVOLVEMENT FALL INTO ONE OF
THE FIVE CATAGORIES
1. SUBNORMAL VISUAL ACUITY
2. PAIN OR DISCOMFORT
3. CHANGE OF APPEARANCE OF LIDS, ORBIT OR
THE EYE
4. DIPLOPIA
5. DISCHARGE OR INCREASE CONJUNGTIVAL
SECRETION
 CHANGE IN APPEARENCE

A. DISCOLORATION
REDNESS OR CONGESTION OF THE LIDS,
CONJUNGTIVA OR SCLERA, MAYBE DUE TO AN
ACUTE INFLAMATORY REACTION TO :
- INFECTION
- TRAUMA
- ALLERGY
- ACUTE GLAUCOMA
SUBCONJUNGTIVAL HAEMORRHAGE IS A
SUDDEN IN ONSET AND BRIGHT RED IN
APPEARANCE
B. SWELLING
- SWELLING OF ONE LID SUGGEST A LOCAL
ABSCESS
- BILATERAL SWELLING INDICATES A MORE
GENERALIZED REACTION SUCH AS BLEPHA-
RITIS, ALLERGY, MYXEDEMA

C. MASS
AN ORBITAL MASS MAY OCCUR, CAUSING
DISPLACEMENT OF THE GLOBE
 EXAMINATION
SYMPTOMS AND SIGNS
MOST OF THE PRESENTING MANIFESTATION
OF THE EYE INVOLVEMENT FALL INTO ONE OF
THE FIVE CATAGORIES
1. SUBNORMAL VISUAL ACUITY
2. PAIN OR DISCOMFORT
3. CHANGE OF APPEARANCE OF LIDS, ORBIT OR
THE EYE
4. DIPLOPIA
5. DISCHARGE OR INCREASE CONJUNGTIVAL
SECRETION
 DIPLOPIA

DOUBLE VISION OCCURS IN PARALYSIS OF THE

EXTRA OCULAR MUSCLES

MONOOCULAR DIPLOPIA OCCURS IN :

- LENTICULAR CHANGES
- MACULAR LESION
- MALINGERING
- HYSTERIA
 EXAMINATION
SYMPTOMS AND SIGNS
MOST OF THE PRESENTING MANIFESTATION
OF THE EYE INVOLVEMENT FALL INTO ONE OF
THE FIVE CATAGORIES
1. SUBNORMAL VISUAL ACUITY
2. PAIN OR DISCOMFORT
3. CHANGE OF APPEARANCE OF LIDS, ORBIT OR
THE EYE
4. DIPLOPIA
5. DISCHARGE OR INCREASE CONJUNGTIVAL
SECRETION
 DISCHARGE
IF THE DISCHARGE IS WATERY (EPIPHORA) AND
NOT ASSOCIATED WITH REDNESS OR PAIN,
CAUSED BY EXCESSIVE FORMATION OF TEARS OR
OBSTRUCTION OF THE LACRIMAL DRAINAGE
SYSTEM

IF THE DISCHARGE IS WATERY BUT

ACCOMPANIED BY PHOTOPHOBIA OR BURNING,
VIRAL CONJUNGITIVITIS OR
KERATOCONJUNGTIVITIS MAYBE PRESENT

A PURULENT DISCHARGE USUALLY INDICATES A

BACTERIAL INFECTION
PHYSICAL EXAMINATION
VISUAL ACUITY
DISTANT VISION.
IN TESTING FOR
DISTANCE A RANGE OF
20 FEET (6 METER) IS
SELECTED, SINCE RAYS
OF LIGT FROM THIS
DISTANCE ARE
PRACTICALLY PARALEL
•SNELLEN CHART
CONSIST OF SQUARE-
SHAPED LETTERS
ARANGED UPON A CHART,
THE SIZE OF THE
LETTERS DIMINISHING
FROM ABOVE DOWN
WARD.
•THE HIGHT OF EACH
LETTER SUBTEND A
VISUAL ANGLE OF 5’ AND
THE WIDTH OF THE
COMPONENT LIMBS A
VISUAL ANGLE OF 1’
THE UPPERMOST
LETER IS OF
SUCH A SIZE
THAT IT CAN BE
READ AT 200
FEET ; THEN
FOLLOW ROWS
OF LETTERS
WHICH SHOULD
BE READ. AT 100,
70, 50. 40, 30, 20,
15 AND 10 FEET.
 - THE VISUAL ACUITY,, IS
EXPRESSED BY FRACTION:

THE NUMERATOR OF WHICH

CORRESPONS TO THE NUMBER
OF FEET SEPARATING THE
PATIENT FROM THE CHART
( PREFERABLY 20 FEET ), AND
THE DENOMINATOR, TO THE
NUMBER INDICATING THE
DISTANCE AT WHICH THE
SMALLEST LETTERS SEEN
SHOULD BE READ BY THE
NORMAL EYE.

- IF THE PATIENT HAS AVERAGE

NORMAL SIGHT,,
THIS IS EXPRESSED V.A = 20/20 (OR
6/6).
•IF HE CAN SEE ONLY THE
THIRD LINE FROM THE
TOP, VA = 20/70.

•IF HE CANNOT READ

MORE THAN THE TOP
LETTER, VA = 20/200

•IF THE PATIENT'S

VISUAL ACUITY IS LESS
THAN 20/200, COUNT THE
EXAMINER'S EXTENDED
FINGERS.

•IF HE CAN COUNT

FINGERS AT I METER VA =
1/60.
- IF HE HAS LESS SIGHT THAN THIS THE
HAND IS MOVED BEFORE THE EYE AND HE IS
CAPABLE OF APPRECIATING SUCH MOVEMENT,
VA = PERCEPTION OF HAND MOVEMENTS OR
1/300.

- IF VISION IS STILL FURTHER REDUCED,

PERCEPTION OF LIGHT IS TESTED AND VA :
LIGHT PERCEPTION.
Notasi
Pinhole
B. NEAR VISION
- JAEGER CHART : CONSIST OF
DIFFERENT SIZES OF ORDINARY
PRFNTERS'S TYPES; THE FINNEST
IS NUMBERED I,, SUCCESIVE
NUMBERS INDICATING COARSER
TYPES.
- ACUITY OF NEAR VISION IS
EXPRESSED BY J, FOLLOWED BY
THE NUMBER CORRESPONDING TO
THE FINEST PRINT WHICH CAN BE
READ.
- J 3 MEANS THAT THE PATIENT
IS ABLE TO READ THE THIRD
PARAGRAPH.
Kedudukan Bola Mata
- EACH EYE IS TESTED SEPARATELY,, ONE EYE IS
BEING COVERED.

- WHEN THE PERSON IS ILLITERATE, OR IN THE CASE

OF CHILDREN,, A SERIES OF LETTER E. WITH SIZES
CORRESPONDING TO THOSE OF SNELLEN CHART, IN
WHICH THE OPENING POINT DOWN WARD,, UPWARD
AND TO THE RIGHT AND LEFT.
 EXTERNAL EXAMINATION

GENERAL INSPECTION WILL REVEAL

ANY OBVIOUS ABNORMALITIES,
SUCH AS:
ASYMMETRY OF THE FACE OR ORBITS.
ANOMALIES OF MOVEMENT OF THE LIDS
SWELLING
CONGESTION
DISCHARGE
LACRIMATION
BLEPHAROSPASM
THE LIDS ARE OBSERVED
- FOR THICKNESS, COLOR AND POSITION
- THE CONDITION OF THEIR MARGIN
WHETHER REDENNED,SWOLLEN,CRUSTED OR
ULCERATED.
- THE POWER OF OPENING & CLOSING
- THE SIZE OF THE PALPEBRAL APERTURE
- THE CONDITION, POSITION &
DIRECTION OF EYE LASHES.
- THE POSITION OF THE
LACRIMAL PUNCTA
 CONJUNCTIVA

- IN ORDER TO EXAMINE
THE WHOLE CONJUNCTIVAL
SAC, IT IS NECESSARY TO
EXPOSE THE PALPEBRAL
CONJUNCTIVA AND THE
FORNICES.

THE LOWER FORNIX IS

EASILY EXPOSED BY
DRAWING DOWN THE
LOWER LID, WHILE THE
PATIENT LOOKS TOWARD
THE CEILING.
THE UPPER PALPEBRAL CONJUNCTIVA IS
EXPOSED BY EVERTING THE UPPER LID.
EVERSION OF THE UPPER LID REQUIRE SOME
PRACTICE.
GRASP THE SKIN OF THE UPPER LID WITH LEFT
INDEX FINGER AND THUMB WHILE PATIENT IS
LOOKING TOWARD HIS FEET, AND ROTATE IT.
CONGESTION OF THE CONJUNCTIVAL VESSELS, LEAVING
RELATIVELY WHITE ZONE AROUND THE CORNEA AND
ACCOMPANIED BY MUCOUS OR MUCOPURULENT SECRETION,
IS INDICATIVE OF CONJUNGTIVITIS.

IF THERE IS MUCH
IRRITATION AND
PHOTOPHOBIA WITH
SOME BLEPHAROSPASM
WE SUSPECT THE
PRESENCE OF
- FOREIGN BODY
- MISPLACED LASHES
- IRRITATION OF THE
CORNEA
CILIARY CONGESTION INDICATES INVOLVEMENT OF
THE INNER EYE, PARTICULARLY INFLAMATION OF THE
IRIS AND SCLERA.
CONJUNGTIVAL CONGESTION OF
ONE EYE ONLY OR SIGN OF
IRRITATION SUCH AS WATERING,
SHOULD LEAD AS TO SUSPECT THE
EFFICIENCY OF THE LACRIMAL
DUCT.

SIMPLE EPHIPORA OR FLOW OF

TEARS ON THE CHEEK MAY BE DUE
MALPOSITION OF THE LOWER
PUNCTUM; OR TO BLOCKAGE OF
THE CANALICULI OR NASAL DUCT.

THE PRESENCE OF DISTENSION

AND INFLAMATION OF THE
LACRIMAL SAC SHOULD BE NOTED.
THE STRUCTURE IS SITUATED IN
THE LACRIMAL FOSA BETWEEN
THE INNER CANTHUS AND THE
NOSE.
THE SCLERA

INSPECTION OF THE SCLERA AROUND THE

CORNEA MAY REVEAL THE RAISED CONGESTED
NODULES OF EPISCLERITIS, WHILE DEEP
SCLERITIS MAY BE SHOWN BY CILIARY
CONGESTION AND OPACIFICATION OF DEEPER
LAYERS OF THE CORNEA AT THE PERIPHERY.
THE CORNEA

THE CORNEAL
SURFACE SHOULD BE
BRIGHT, LUSTROUS
AND TRANSPARANT.
ANY LOSS OF
SUBSTANCE, SUCH AS
ABRASION, MAY
EASILY OVERLOOKED
WITHOUT SPECIAL
METHOD OF
EXAMINATION
 PLACIDO'S KERATOSCOPIC DISC, ON
WHICH ARE PAINTED ALTERNATING
BLACK AND WHITE CIRCLES.

THE OBSERVER LOOKS THROUGH A HOLE IN

THE CENTRE AT THE CORNEAL IMAGE AS
REFLECTED FROM A LIGHT BEHIND THE
PATIENT, IRREGULARITIES IN THE RINGS
BETRAY IRREGULARITIES ON THE CORNEAL
SURFACE.
FLUORESCEIN TEST IS THE MOST USEFULL
CORNEAL STAINING TO DELICATE AREAS
DENUDED OF EPITHELIUM
- ABRASIONS
- MULTIPLE EROSIONS
- ULCERS
OPACITIES OF THE
CORNEA MAY BE SO FAINT
THAT THEY REQUIRE
MINUTE INVESTIGATION
AND THE SAME IS TRUE OF
THE DETAILS AND DEPTH
OF GROSS OPACITIES.
THESE CAN BEST BE
STUDIED WITH THE SLIT
LAMP.
OF PARTICULAR
IMPORTANCE IS THE
DETECTION OF THE
MINUTE EPITHELIAL OR
SUBEPITHELIAL LESIONS
OF A PUNCTATE KERATITIS
AS WELL AS OF KERATIC
PRECIPITATES (KP).
IN MANY DESEASES NEW VESSELS
(NEOVASCULARIZATION) ARE FORMED IN THE
CORNEA.
THE SENSIBILITY OF THE CORNEA
MAY BE TESTED BY TOUCHING IT IN
VARIOUS SPOTS WITA A WISP OF
COTTON-WOOL TWISTED TO A FIND
POINT AND COMPARING THE EFFECT
WITH THAT ON THE OPOSITE SIDE.

NORMALLY THERE IS A BRISK

REFLEX CLOSSURE OF THE LID.
THE ANTERIOR CHAMBER.
THE ANTERIOR CHAMBER IS SHALLOW IN
EXTREME YOUTH AND IN OLD AGE; AT THE
OTHER PERIOD OF LIFE IT IS NORMALLY
ABOUT 2,15 MM DEEP, THE DEPTH OF THE
ANTERIOR CHAMBER IS ESTIMATED BY THE
POSITION OF THE IRIS.

THE ANTERIOR CHAMBER IS SHALLOW IN

CLOSED -ANGLE GLAUCOMA; ABNORMALLY
DEEP IN IRIDOCYCLITIS.
IT IS FREQUENTLY UNEQUAL IN DEPTH IN
DIFFERENT PARTS FOR EXAMPLE:

- IT MAY BE DEEPER AT THE PERIPHERY

THAN IN THE CENTRE IN IRIDOCYCLITIS;

- ON THE OTHER HAND, WHEN THE IRIS

IS BULGED FORWARDS (IRIS BOMBE) IT
IS FUNNEL SHAPED, THE CENTRE BEING
DEEP, THE PERIPHERY SHALLOW.

- SUBLUXATION OF THE LENS CAUSES IT

TO BE DEEPER ON ONE SIDE THAN ON
THE OTHER.
Gambar gonioskopi
AFTER CONSIDERING THE DEPTH,,
ATTENTION MUST BE PAID TO THE
CONTENTS.

IN INFLAMTORY CONDITIONS OF THE UVEAL

TRACT WHEN THE PERMEABILITY OF THE
VESSELS IS INCREASED, THE AQUEOUS MAY
CONTAIN PARTICLES OF PROTEIN OR
FLOATING CELLS.
IN SLIGHTER DEGREES THEIR PRESENCE PRODUCT
AN AQUEOUS FLARE WHICH MAY BE VISIBLE
ONLY WITH THE SLIT LAMP WHEN ITS BEAM IS
FOCUSED TO A POINT;

IN ITS MORE EXTREME DEGREES A TURBIDITY

EXISTS EASILY DISTINGUISHABLE BY THE
LOUPE.

- IN THE POSTERIOR SURFACE OF THE CORNEA

PROTEIN MATERIAL OR CELLS ARE DEPOSITED
(KP: KERATIC PRECIPITATES).
- OCCASIONALLY THERE IS PUS IN THE
ANTERIOR CHAMBER FORMING A
SEDIMEN AT THE BOTTOM,, THE SURFACE
OF WHICH IS LEVEL (HYPOPION).
- A SIMILAR COLLECTION OF BLOOD
MAY OCCUR AFTER CONTUSIONS OR
SPONTANEOUSLY (HYPHAEMA).
THE IRIS
THE COLOUR OF THE IRIS AND THE CLARITY
OF ITS PATTERN SHOULD FIRST BE NOTED.

SOME PARTS OF THE IRIS MAY BE OF

DIFFERENT COLOUR CONDITIONS WHICH IS
KNOWN AS HETEROCHROMIA IRIDIS.
A GREY IRIS WITH AN ILL-DEFINED
PATTERN SUGGESTS ATROFY FROM
CYCLITIS AND PATCHES OF ATROFY
SUGGEST GLAUCOMA
“MUDDINES OF THE IRIS " IS THE
EXPRESSION USED FOR INDISTINCTNESS
OF THE PATTERN, CAUSED BY INFLAMATORY
EXUDATES; A MUDDY IRIS, WITH
IRREGULAR PUPIL AND SLUGGIST REACTION
TO LIGHT, IS INDICATIVE OF IRITIS OR
IRIDOCYCLITIS.
THE POSITION OF THE IRIS MUST BE NOTED,
ESPECIALLY THE PLANE WHICH IT LIES.

SPESIAL ATTENTION SHOULD PE PAID TO ANY

ADHESIONS( SYNECHIAE ), ANTERIOR (TO THE
CORNEA) OR POSTERIOR (TO THE LENS CAPSULE).
TREMULOUSNESS OF THE IRIS
(IRIDODONESIS) SEEN WHEN THE EYES
ARE MOVED RAPIDLY IF THIS TISSUE IS
NOT PROPERLY SUPPORTED BY THE LENS:
-IN ABSENCE OF THE LENS
(APHAKIA)
-SUB LUXATION OF THE LENS.
THE PUPILS
THE CONDITION OF THE PUPILS SHOULD BE
EXAMINED AT AN EARLY STAGE IN EVERY
ROUTINE EXAMINATION OF THE EYES;
CERTAINLY BEFORE ANY MIDRIATIC IS
EMPLOYED.
NOTE THE SIZE, SHAPE AND POSITION OF THE
PUPILS,, ALSO ITS REACTION TO LIGHT
ACCOMODATION AND CONVERGENCE.
THE LENS
OPACITIES OF THE LENS IS CALLED
CATARACT.
THE CATARACT OPACITIES ARE SEEN BY
OBLIQUE ILLUMINATION AS GRAY, WHIFE OR
YELLOWISH PATCHES; BY RETRO -
ILLUMINATION WITH OPHTHALMOSCOPE THEY
APPEAR BLACK.
PALPATION GIVES INFORMATION CONCERNING:

(1) TENDERNESS IN THE CILIARY

REGION
(2) TENSION OF THE EYEBALL
(3) EXISTENCE OF TUMOR

INTRA OCULAR PRESSURE

THE TENSION OF THE GLOBE MAY BE ESTIMATED
BY PALPATION.
FOR ACCURATE
MEASURMENT OF THE
INTRAOCULAR PRESSURE
USE THE TONOMETER
SCHIOTZ.
TONOMETRY BY TONOMETER SCHIOTZ
- THE EYE IS ANESTHETIZED. WITH TWO
INSTILLATION OF PANTOCAINE.

- THE PATIENT SHOULD LIE ON A COUCH, THE EYES

DIRECTED UPWARD.

- THE LIDS ARE SEPARATED WITH THE FINGERS

WITHOUT PRESSING ON THE EYE BALL.
-THE TONOMETER IS
ALLOWED TO REST BY ITS
OWN WEIGHT ON THE
CENTER OF THE CORNEA.

- THE NEEDLE OF THE

INSTRUMENT BECOMES
DEFLECTED TO A CERTAIN
NUMBER WHICH AN
ACCOMPANYING SCALE
TRANS LATES INTO A
DEFINITE NUMBER OF
MILLIMETERS OF MERCURY.

- THE MEAN NORMAL

INTRAOCULAR PRESSURE IS
16.1 OF Hg., WITH
STANDAR DEVIATION OF +
2.8 MM.
THE OPHTHALMOSCOPIC EXAMINATION
BEFORE ATTEMPTING TO SEE THE FUNDUS,
THE MEDIA MUST BE EXAMINED.

EXAMINATION WITH OPHTHALMOSCOPE AT A

DISTANCE.

THE DISTANCE BETWEEN PATIENT AND

EXAMINER IS ABOUT 15 INCHES.
- THIS METHOD EXPLORES ALL THE MEDIA:
CORNEA, AQUEOUS LENS AND VITREUS.
- IN THE NORMAL EYE A HOMOGENEDUS
ORANGE RED REFLEX ISOBTAINED.(FUNDUS
REFLEX.)
-IF OPACITIES EXIST IN ANY OF THE MEDIA,
THEY WILL APPEAR AS DARK OR BLACK SPOTS
UPON THE COLORED BACKGROUND OF THE PUPIL.
Gambar oftalmoskop direk dan indirek
THE DIRECT METHOD OF
OPHTHALMOSCOPIC EXAMINATION.

@ THE EXAMINER SITS OR STANDS TO THE

SIDE OF AND FACING THE PATIENT.
@ THE OPHTHALMOSCOPE Is BROUGHT
DIRECTLY IN FRONT OF THE PATIENT'S EYE
AS CLOSE AS POSIBLE (NOT MORE THAN 1
INCH)
@ FOR EXAMINATION OF THE RIGHT EYE,
THE EXAMINER MUST BE ON THE RIGHT
SIDE AND THE OPHTHALMOSCOPE MUST BE
PLACED BEFORE THE RIGHT EYE OF THE
OBSERVER.
@ WHEN THE LEFT EYE IS BEING EXAMINED
THE EXAMINER MUST BE TO THE LEFT, AND
USE HIS LEFT EYE.
THE INDIRECT METHOD OF
OPHTHALMOSCOPIC EXAMINATION.
- WITH INDIRECT METHOD THE IMAGE IS INVERTED AND
MAGNIFIED ABOUT FOUR DIAMETERS.

- A STRONG CONVEX LENS (+ 20.00 D) IS HELD ABOUT ITS

FOCAL DISTANCE IN FRONT OF THE EYE TO BE EXAMINE
(2 TO 3 INCHES)
THE DIRECT AND INDIRECT

THE DIRECT METHOD GIVE AN ERECT

IMAGE WHICH IS HIGHLY MAGNIFIED
(ABOUT 15 X). A SMALL PORTION OF
THE FIELD IS SEEN AT A TIME.
THE INDIRECT METHOD GIVES A LARGER
FIELD OF VIEW, MAGNIFICATION IS
SMALLER (A BOUT 4 X) THE IMAGE IS
INVERTED.
THE NORMAL FUNDUS

IT PRESENTS AN ORANGE
- RED SURFACE UPON
WHICH THE DISK, THE
BLOOD VESSELS AND THE
MACULA ARE
DISTINGUISHED.
THE DISK (PAPILLA.)
REPRESENT THE ENTRANCE OR
HEAD OF THE OPTIC NERVE; IT
USUALLY IS CIRCULAR, BUT
SOMETIMES OVAL IN FORM. ITS
COLOR IS LIGHT PINKISH THE
MARGIN IS SHARLY DEFINED. THE
CENTER OF THE PAPILLA PRESENTS
A FUNNEL-SHAPED DEPRESSION
FORMED BY THE SEPARATION OF
THE NERVE FIBERS ; THIS APPEAR
WHITER THAN THE REST OF THE
DISK ----> PHYSIOLOGIC
DEPRESSION OR CUP.
THE CENTRAL ARTERY
AND
VEIN OF THE RETINA.

- PASS ALONG THE INNER

WALL OF THE
EXCAVATION.

- UPON REACHING THE

SURFACE OF THE DISK
USUALLY DIVIDE INTO
SUPERIOR AND
INFERIOR DIVISIONS.

-EACH OF THESE SOON

DIVIDES GIVING OFF NASAL
AND TEMPORAL BRANCHES.
THE REGION OF THE
MACULA LUTEA.

- IT IS THE MOST IMPORTANT

PART OF THE FUNDUS.
-SITUATED LESS THAN TWO
DISK DIAMETERS TO THE
TEMPORAL SIDE OF THE DISK.
-IN THE LINE OF DIRECT
VISION.
-IT IS DEVOID OF VISIBLE
VESSELS.
-DARKER THAN THE REST OF
THE FUNDUS.
-A BRIGHT SPOT IS SEEN IN
ITS CENTER CORRESPONDING
TO THE POSITION OF THE
FOVEA CENTRALIS.