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Fundus Examination
Fundus Examination
Fundus Examination
Punctate stippling-periphery
PARTS
peripheral retina and pars plana CONTENTS - DENTATE PROCESSES ORAL BAYS
NORMAL VARIANTS : Meridoneal fold enclosed bay microcystic degeneration granulation tissue
LAMINA CRIBROSA
NEURORETINAL RIM
DISC: LOCATION nasal to geometric axis DIAMETER 1.5mm [1 disc diameter] COLOR Pale pink SHAPE Circular EDGES Regular TERMINATION OF ALL LAYERS EXCEPT NFL CUP: C/D ratio
0.3 to 0.5
RETINAL SYSTEM :
CENTRAL RETINAL ARTERY AND CENTRAL RETINAL VEIN 4 major branches Arterioles Venules Capillaries CILIARY SYSTEM : POST.CILIARY ARTERIES Choriocapillaries
Specialised region of retina Diameter 5.5 mm Location 2 DD - temporal margin of disc Color Yellow; deep pigmented 4 zones : Foveola -0.35 mm Fovea -1.50 m Parafovea Perifovea Retinal vessels Cilioretinal artery
Fovea - Thin bottom thick basement margin - prone for macular holes -Henles layer-oblique cones Foveola - Thin pit , Densely cones Bowing vitreally- fovea externa Umbo - Tiny depression - Foveal light reflex bouquet of cones - narrowed gateau nucleaire
drusen
Why it is performed: It can detect some signs & physiological effects of various circulatory, metabolic and neurological disorders.
Routinely used to assess and diagnose vitro-retinal
diseases (such as Diabetic retinopathy, retinal tear and detachment, macular hole, retinal haemorrhage, retinal artery and vein occlusion, choroidal tumor, or macular edema), optic nerve defects, and hereditary diseases.
Fundus examination is used to: Identify and locate vitro-retinal and optical
nerve defects caused by eye diseases or trauma. Examine the extent of the defects or abnormalities to plan a proper treatment. Evaluate the success of treatment.
Combination of phenylephrine [2.5 %] & tropicamide [1 %] then eyes closed Dilation attained = 45 min Normal reactivity = 4 - 8 hrs Conditions which to avoid : iris supported lens shallow AC Head injury
- retinal arterioles retinal haemorrhage microaneurysm attached retina hole /break - Retinal venules detached retina outine of break
- exudate edema - vitreous opacity vitreous bleed - pigmentation detached choroid - ora serrata /drusen hyperpigmentation
Vitreoretinal chart
METHODS OF EXAMINATION
DIRECT OPHTHALMOSCOPY
INDIRECT OPHTHALMOSCOPY INDIRECT SLIT LAMP BIOMICROSCOPY
DIRECT OPHTHALMOSCOPY
fovea Viewing aperture contains illumination openings 1. spots 4.fixation target 2.streak projection 5. calibration grid 3.Red free filter
Evaluating fundus :
Indirect ophthalmoscopy
Magnification = 2 to 4 X
Field of view = 40 to 50 degrees Optimal working distance = 40 to 50 cms
condensing lens.
12 0 Clock meridian towards patient feet and transforming the image rotated 180 degrees .
Follow vessels and bifurcations in each quadrant then with scleral indentation terminal branches. Ora serrata then fundal lesions with relations .
inverse of magnification
Hence wider field will have less magnification with
fundus view.
To examine periphery between equator and ora serrata by creating a mound to view.
Start superonasal superior ,superotemporal, Inferotemporal, inferior, inferonasal
Done on an inverted fundus chart and paper is turned as patients gaze direction changes in respective clock hour meridian.
Evaluating fundus :
- Nerve fibre layer thickness [red free filter] - Macular lesion level [slit beam side way movement] [watzke Allen test] - Vitreous opacities, strands.
Concavo plano contact lens - virtual , erect image Combines stereopsis, high illumination, high magnification [ 10 x] , 20 degree field,.. Flat central portion posterior vitreous and pole Angled mirror - 73 deg - area around posterior pole 67 deg - equatorial fundus 59 deg - peripheral retina Eliminates total internal reflection by replacement with cornea goldmann contact lens interface.
Provides wide field 130 degree and high power lens A real inverted magnified image is formed
It is used in both posterior fundus examination and also Laser pan retinal photo Coagulation.
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