Basics of

Optic fundus
Exam
Objectives

 Describe Patient preparation

 Demonstrate correct procedure using
the ophthalmoscope
 Describe the normal fundus

 Describe abnormal findings, and

recognize disease process
Direct Ophthalmoscope

Brow Rest

Viewing aperture Peephole

Lens wheel
Beam Selector
Lens power

Rheostat

Handle
Normal Ocular Fundus

Arterioles

Optic cup
Fovea

Optic disc

Vein
Normal fundus
 Disc: Clear outline; optic cup is pale and
centrally located.
Normal fundus
 Disc: Clear outline; optic cup is pale and
centrally located.

 Retina: Normal red/orange colour, macula is

dark. The macula is approximately 2 disc
diameters away from disc and 1.5 degrees
below horizon.
Normal fundus
 Disc: Clear outline; optic cup is pale and
centrally located.

 Retina: Normal red/orange colour, macula is

dark. The macula is approximately 2 disc
diameters away from disc and 1.5 degrees
below horizon.

 Vessels: Arterial/venous ratio 2 to 3; the

arteries appear a bright red, the veins a slightly
purplish colour.
 Optic nerve
 Consists of 1 million axons that arise from the
retina.
 Leaves the eye through the sclera – optic
canal – into the cranium.
What to observe

 Optic disc- colour/size/edges

 Cup – size

 Blood vessels –
number/width/tortuosity
 Macular / fovea

 Other findings –hemorrhages, soft

and hard exudates, edema
Procedure
 Ask patient to fix stare at far object
 Turn on scope and set dial to 0
 Remember right eye right hand
 Rest hand on patients forehead
 Begin at arms length away, should see red
reflex.
 Move closer until optic disc visible ( approx. 3-
5cms) Turn dial until disc in focus.
 Hyperopic – turn disc for plus numbers (green)
 Myopic – minus numbers (red)
 Micro Spot Aperture: Allows quick visual
entry in very small, undilated pupil

 Small Aperture: Provides easier view of

fundus through undilated pupil

 Large Aperture: Standard aperture for

dilated pupil and general examination of
the eye

 Fixation Aperture: Features graduated

cross-hairs for measuring eccentric
fixation or for locating lesions and other
abnormalities

 Slit: Used to determine various levels of

lesions and tumors
 Cobalt Filter: Blue filter used with
Fluorescein dye permits easy
viewing of small lesions, abrasions
and foreign objects on the corneal
surface

 Red Free Filter: Green filter used

to study blood vessels and retinal
nerve fiber layer (RNFL)
Flame-shaped hemorrhage

Microaneurysm / dot blot hemorrhage

Exudates
Macular edema
Cotton-wool spot
Vitreous hemorrhage
Neovascularization
Hypertensive Retinopathy
Modified Scheie Classification
 Grade 0: No changes
 Grade 1: Minimal arteriolar narrowing
 Grade 2: Obvious arteriolar narrowing
with focal irregularities
 Grade 3: Grade 2 + retinal hemorrhages
and/or exudate
 Grade 4: Grade 3 + swollen optic nerve
(Malignant hypertension)
Hypertensive Retinopathy
Grade 2
Arteriovenous
nicking in
association
with
hypertension
Grade 2
(black arrows)
Hypertensive Retinopathy
Grade 3
 Flame-shaped
hemorrhage
in association
with severe
hypertension
Grade 3 (red
arrow)
Hypertensive Retinopathy
Grade 4
 Papilledema from
malignant
hypertension. There
is blurring of the
borders of the optic
disk with
hemorrhages (red
arrows) and
exudates (white
arrow)