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Anel Test: Funduscopy Examination
Anel Test: Funduscopy Examination
Topical anesthesia is given and dilatate the lacrimal punctum. Anel needle inserted in the
punctum and canaliculi lakrima. Spraying is done with normal saline. Asked whether the patient
feels fluid in the throat or seen whether the swallowing reflex occurs in patients. If it’s appear, it
means good excretory function of the lacrimal system. if it’s not appear, then there is a blockage
of the nasolacrimal duct.
Funduscopy Examination
Medications
Contra-indications to use
Disc
o margins are sharp
o color: yellowish orange to creamy pink
o shape: round or oval
o Cup to disc ratio: less than half
Vessels
o AV ratio
o AV crossing: no indentation
o No arterial light reflex
Fundus background
o No exudates or hemorrhages
o color : red to purplish
Macula
o macula is located 2.5 disc distance temporal to disc
o no vessels are noted around Macula
o it may be slightly pigmented
Normal fundus: Vessels emerge from nasal side of disc. Arteries are narrower than veins.
Pathological Optic Cupping : Note cup-to-disc ratio at least 0.8 (physiologic limit of 0.5).
The optic disc is elevated and its surface is covered by cotton wool spots (damaged axons) and
flame hemorrhages (damaged vessels). Four I's: increased intracranial pressure (papilledema),
infarction, inflammation, infiltration (by cancer).
Arterio-Venous (AV) Nicking
Chronic hypertension stiffens and thickens arteries. At AV crossing points (arrow) arteries indent
and displace veins.
Caused by microinfarcts. Exploded ganglion cell axons extrude their axoplasm into retina. Long
DDx: hypertension, diabetes, HIV, severe anemia or thrombocytopenia, hypercoagulable states,
connective tissue disorders, viruses, and others.
Emboli and Infarcts
Roth Spot