RAJVIN SAMUEL PONRAJ

y APPERANCE : Uniform red

Punctate stippling-periphery

y PARTS

Varies-color of individual Normal choroidal vessels - Invisible DISC

VESSELS MACULA PERIPHERY

y ORA SERRATA

Junction between 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

y RETINAL SYSTEM :

CENTRAL RETINAL ARTERY AND CENTRAL RETINAL VEIN 4 major branches Arterioles Venules Capillaries y 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 y Retinal vessels y Cilioretinal artery
y y y y y

Fovea - Thin bottom thick basement margin - prone for macular holes -Henle s layer-oblique cones Foveola - Thin pit , Densely cones Bowing vitreally- fovea externa Umbo - Tiny depression - Foveal light reflex bouquet of cones - narrowed gateau nucleaire

y Posterior pole

loss of foveal light reflex drusen

Retinal vessels narrowing, increased light reflex Equator - chorio , reticular pigmentary degeneration Vitreous - liquefaction , floaters ,..

Why it is performed: It can detect some signs & physiological effects of various circulatory, metabolic and neurological disorders.
y 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.

y Fundus examination is used to: y Identify and locate vitro-retinal and optical

nerve defects caused by eye diseases or trauma. y Examine the extent of the defects or abnormalities to plan a proper treatment. y 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

Optic Disc drawing

METHODS OF EXAMINATION
y DIRECT OPHTHALMOSCOPY y INDIRECT OPHTHALMOSCOPY y INDIRECT SLIT LAMP BIOMICROSCOPY

DIRECT OPHTHALMOSCOPY

y An erect upright virtual image y Magnification = 15 x y Field of view = 5 degrees y Optimal working distance upto 2-3 cms y No stereoscopic view y Several plus and minus dial up lenses y Structures - optic nerve, blood vessels of posterior pole

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

y An inverted reverse real image y Magnification = 2 to 4 X y Field of view = 40 to 50 degrees y Optimal working distance = 40 to 50 cms y Good illumination & stereopsis y Ease of use with scleral indentor y Lenses from 14 to 30 D range y Positioning of patient

y Head set adjustment y Eye piece adjustment y Light beam adjustment y Choosing ,positioning and technique to hold

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 .

 Field of view is proportional to power of lens but

inverse of magnification
 Hence wider field will have less magnification with

higher powered lenses.

 Higher power lenses used in small pupils, peripheral

fundus view.

-Thimble scleral depressor -Pencil type depressor -Cotton tipped applicator

To examine periphery between equator and ora serrata by creating a mound to view. Start superonasal superior ,superotemporal, Inferotemporal, inferior, inferonasal

y An inverse real reversed image with hand held lenses y Field of view = 30 to 40 degrees y Lens power = + 78 or + 90 D , other lenses= + 60 to 132 D y Magnifying knob to 10 X or 16 X y Drawing the slit lamp biomicroscopic view:

Done on an inverted fundus chart and paper is turned as patients gaze direction changes in respective clock hour meridian.

y Performing indirect slit lamp biomicroscopy y Evaluating fundus :

y A plano concave non contact lens y High minus power [-55 D] y Virtual erect image y To visualize - optic cupping , peri papillary changes

- 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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