check if opthalmoscope is in good working condition inform examiner that u would tell the pt that u r going to flash bright light in his eyes to have a look at the back of his eyes and during examination u will come very near to his face ask him to fix his gaze at a distant object DIM LIGHTs examination of rt eye e ophthalmoscope held in rt hand and look through e ur rt eye vice versa is for lt eye --hold instrument to eye e index finger on thelens dial --approach from shallow angel (15--20 degree) approach on the same level as equator --note and comment on red reflex --note and comment on anterior surface of eye --come near and focus on retina --identify optic disc and comment on colour ,cup,size and margins --follow blood vessels in 4 quadrants --seek to identify the macula and fovea --some times 2 eyes of dummy will have 2 different pathologies --report ur findings to the examiner common slides kept r hypertensive retinopathy -diabetic retinopathy 3--pappiloedema --normal
diabetic retinopathy diabetic retinopathy (lazer) extensive pan retinal photocoagulation for previous proliferative retinopathy macula looks healthy, visual acuity at this stage is 6/9 and would be maintained at this level
diabetic retinopathy(maculopathy) rt fundas of young type 1 diabetic showing hard exudate close to macula.visual acuity is 6/5,this is an early case of diabetic maculopathy and may require laser treatment
diabetic retinopathy(background_) fundas photograph rt eye, dot and blot haemorrhagess mainly temporal to the macula and a nerve fiber haemorrhage in the upper part of fundas,there is a cresent temporal to the optic disc which is e in normal limits
diabetic retinopathy(proliferative) fine new vessels on the optic disc,dot/blot haemorrhages elsewhere, rainbow type leison in the lower part of the pic is an artefact,pt require panretinal photocoagulation to preserve vision
diabetic retinopathy(maculopathy and cotton wool spot) diabetic retinopathy(maculopathy and cotton wool spot) area of hard exudate adjacent to lt macula(circinate) e central dot haemorrhages,cotton wool spot(retinal ischemia) inferior to optic disc,visual acuity 6/6, for focal laser
diabetoic retinopathy(maculopathy) exudation temporal to macula and close to the fixation marker in the lt eye ,there r dot and blot haemorrhages temporal to macula ,this is classified as diabetic maculopathy
diabetic retinopathy(microaneurysm) there r some red dots in the fundas which represent microaneurysm and small dot haemorrhages, the optic disc is normal and the optic disc vessel on it r also e in normal limits
Acute closed angke glaucoma --------------------------------------------------------- this is a microangiopathy chacterized by microaneurysm, dot and blot haemorrhages causing occlusion and leakage resulting in retinal ischemia
Image showing the funduscopic findings in miliary tuberculosis - note the pale lesions (marked by arrow) representing tuberculous infiltrates of the choroid. Miliary tuberculosis is a complication of primary infection with Mycobacterium tuberculosis. Miliary TB most frequently affects the lungs (90%), meninges (tuberculous meningitis 25%), liver/spleen, kidneys, adrenal glands and the choroid
this is a central retinal vein occlusion,the central vein became blocked and hydrostatic pressure developed which resulted in multiple ruptures e i n the capillary bed of the retina giving the appearance of 360 degree of retinal haemorrhage
retinal vein occlusion retinal ischemia leading to neovascularisation which increases the risk of intraoccular haemorrhage
In the nonproliferative stage, capillaries are damaged. But weak new capillaries haven't started to grow on the ------------------------------------------------------------------------------------- In the proliferative stage, weak new capillaries are growing throughout the retina. Bleeding into the vitreous may occur.
Papilledema showing blurred disc margins and dilated tortuou Papilledema showing blurred disc margins and dilated tortuous vessels
IDDM IDDM 1--explain to the examiner that u would introduce to the pt 2--explain to the examiner that u would ask permission of the patient to examine the back of his eye 3--explain to the examiner that u would darken the room and ask pt to focus on an object in the far corner and not look directly into ophthalmoscope 4--assess the lens for opacity which is common eye finding in diabetics there should be an absence of red reflex if present and an inablity to assess the fundus 5--once cataract hasbeen excluded, assess the iris for rubeosis(new vessel formation),which puts the pt at risk for glaucoma 6--assess the retina ,in the examination a slide is projected BACKGROUND DIABETIC RETINOPATHY(NON PROLIFERATIVE) appears as exudates.haemorrhages and microaneurysms.Microaneurysm leak plasma and lipid seen as hard exudate,Soft exudates r site of small retinal infarcts IN PROLIFERATIVE DIABETIC RETINOPATHY COMMON IN IDDM AFTER "20 YEARS there is a new vessel formation near the optic disc and fibrosis, The pt is then at the risk for haemorrhage,retinal detachment and ultimately blindness 7--repeat the examination on opposte side 8--explain to the examiner that u would thank the pt for cooperation
Hypertensive retinopathy FINDINGS look for the signs of vascular disease copper wiring of arteris (GRADE1) --arteriovenous nipping(2) --flame and blot haemorrhages and cotton wool exudates(3) --papiloedema(4)
Cotton Wool spots result from occlusion of retinal pre-capillary arterioles supplying the nerve fibre layer with concomitent swelling of local nerve fibre axons. They are white, flufy lesions in the nerve fibre layer. They are very common in Diabetic Retinopathy, especially if the person is also hypertensive. Hard exudates are yellow deposits of lipid and protein within the sensory retina. Accummulations of lipids leak from surrounding capillaries and microaneuryisms, they may form a circinate pattern
proliferative Diabetic Retinopathy The above image was non proliferative, The Image below is Proliferative proliferative Diabetic Retinopathy
Central Retinal Venous Occlusion (CRVO) Central Retinal Venous Occlusion (CRVO) Blood and thunder” – optic disc blurring, macular edema, pan-retinal hemorrhages, tortuous dilated veins, cotton wool spots
fantastic information! thank you very much for all the information you put on line for us! Very professional very technical I haven't seen anything like this on this forum. it is a masterpiece! Daniela
to describe fundal examination can any one tell me very nicely how to describe different conditions on fundoscopic examination to an examiner. :?: thanks :lol:
