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    Ophthalmoscopy and DiseaseMgmt

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    Sheral Aida
    An ophthalmoscope is used to examine the inner eye or retina, allowing clinicians to diagnose various eye and systemic diseases based on abnormalities seen. Many conditions like diabetes, hypertension, and neurological disorders manifest changes in the retina that can be detected during an exam. Common findings include microaneurysms and hemorrhages in diabetic retinopathy, thickened vessel walls and AV nicking in hypertension, drusen in age-related macular degeneration, papilledema in increased intracranial pressure, and retinal detachments or tumors. Examining the retina is especially important for managing diseases like diabetes that can cause vision loss if left untreated.

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    Ophthalmoscopy and DiseaseMgmt

    Uploaded by

    Sheral Aida
    239 views21 pages
    An ophthalmoscope is used to examine the inner eye or retina, allowing clinicians to diagnose various eye and systemic diseases based on abnormalities seen. Many conditions like diabetes, hypertension, and neurological disorders manifest changes in the retina that can be detected during an exam. Common findings include microaneurysms and hemorrhages in diabetic retinopathy, thickened vessel walls and AV nicking in hypertension, drusen in age-related macular degeneration, papilledema in increased intracranial pressure, and retinal detachments or tumors. Examining the retina is especially important for managing diseases like diabetes that can cause vision loss if left untreated.

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    An ophthalmoscope is used to examine the inner eye or retina, allowing clinicians to diagnose various eye and systemic diseases based on abnormalities seen. Many conditions like diabetes, hypertension, and neurological disorders manifest changes in the retina that can be detected during an exam. Common findings include microaneurysms and hemorrhages in diabetic retinopathy, thickened vessel walls and AV nicking in hypertension, drusen in age-related macular degeneration, papilledema in increased intracranial pressure, and retinal detachments or tumors. Examining the retina is especially important for managing diseases like diabetes that can cause vision loss if left untreated.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    239 views21 pages

    Ophthalmoscopy and DiseaseMgmt

    Uploaded by

    Sheral Aida
    An ophthalmoscope is used to examine the inner eye or retina, allowing clinicians to diagnose various eye and systemic diseases based on abnormalities seen. Many conditions like diabetes, hypertension, and neurological disorders manifest changes in the retina that can be detected during an exam. Common findings include microaneurysms and hemorrhages in diabetic retinopathy, thickened vessel walls and AV nicking in hypertension, drusen in age-related macular degeneration, papilledema in increased intracranial pressure, and retinal detachments or tumors. Examining the retina is especially important for managing diseases like diabetes that can cause vision loss if left untreated.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 21

    Purpose of Ophthalmoscopy

    An ophthalmoscope is used to examine the inner eye,


    also called the retina or the fundus
    It is the only way (and place in the body) that veins and arteries
    can be seen in their natural state, non-invasively (in vivo).
    The funduscopic exam is (potentially) valuable clinically
    because many disease states can be diagnosed based
    on evidence seen in the inner eye.
    includes both eye-specific disorders, as well as systemic and
    neurological conditions affecting the body in general
    diseases leave clues or "footprints" which appear as changes
    locally in the vessels and nerves of the fundus.
    Observing the vessels in the fundus can provide an
    excellent idea of the state of the vasculature of other
    organs in the body.
    Diseases which Manifest in the Fundus
    AIDS (CMV retinitis), hypertension, and diabetes are
    systemic diseases that manifest themselves in the fundus
    and thus ophthalmoscopy can provide valuable clues to their
    diagnosis.
    Papilledema is a sign of concussion or increased intra-
    cranial pressure.
    Other important eye disorders such as Glaucoma, Age-
    related Macular Degeneration, and Diabetic Retinopathy can
    be detected.
    Vein/Artery Occlusions -- related to Stroke
    Tumors in the retina (melanoma)
    Purpose of Ophthalmoscopy
    Eye Anatomy
    Ophthalmoscope Optical System
    PURPOSE: to provide illumination and a viewing into the back
    of the eye
    Design conditions for optimal view of fundus:
    the light goes through the pupil
    the light is not reflected by the cornea back into
    the doctors eye
    the light illuminates a large portion of the retina
    the visible area of the retina overlaps with the
    illuminated area of the retina
    Traditional Ophthalmoscope
    Filters & Apertures
    Open/clear
    Red-free
    Polarizer
    6 Apertures :
    l
    Micro-spot
    Small
    Large
    Cobalt
    Fixation
    Slit
    3 Filters:
    Lens Wheel
    -25 to +40
    diopter range
    Ophthalmoscope Technique
    PanOptic (wide view) Ophthalmoscope
    1. SET TO SMALL SPOT (green line on aperture dial)
    2. FOCUS ACROSS THE ROOM on something 10 ft. away
    3. EXAM POSITION
    ! 6 inches away and at a 15 to 20 degree angle on the temporal side
    of your patient
    ! Looking through the scope, shine light at patients eye and look for
    the red retinal reflex
    4. APPROACH & MAKE CONTACT
    ! Carefully follow the red reflex into the pupil
    ! The eyecup must contact patients brow to achieve view
    5. COMPRESS EYECUP TO MAXIMIZE VIEW
    ! Make minor, fine-tuning adjustments to the focus if needed
    PanOptic Technique
    Ophthalmoscope for Disease Management
    In primary care, the ophthalmoscope is most often
    used on patients who:
    Are known or suspected to have Diabetes
    Are known or suspected to have
    Hypertension
    Complain of Headaches
    Have had any kind of Head trauma/injury
    Have loss of Vision or degraded vision
    (flashes, distortion, shadows)
    Are undergoing a routine Physical
    Examination
    Have eye Pain including abrasions
    (scratches) and foreign bodies in the eye
    .
    PREVELANT DISEASES DIAGNOSED SPECIALTY
    Diabetic Retinopathy
    only 30% of diabetic patients see the ophthalmogist for
    annual exam
    Internal Medicine, Family
    Medicine, Nephrology
    Hypertensive Retinopathy
    useful in finding undetected hypertension
    helps monitor control & management of disease
    Internal Medicine, Family
    Medicine, Nephrology
    Papilledema/Head Trauma
    patient complaint of headaches
    Internal Medicine, Family
    Medicine, Emergency Medicine
    Central Nervous System Problems
    manifestation commonly seen in retina
    Neurology
    Shaken Baby Syndrome
    can visualize retinal hemorrhages consistent with
    syndrome
    Pediatrics, Family Medicine
    Foreign Bodies/Corneal Abrasions Internal Medicine, Family
    Medicine, Emergency
    Medicine, Pediatrics
    Ophthalmoscope for Disease Management
    Clinically valuable
    many systemic disease states manifest in the
    fundus
    AIDS, hypertension, diabetes
    Eye is extension of Central Nervous System
    neurological disorders
    Looking for? Dots, Blots, Spots
    + Abnormal blood vessel growth
    (neovascularization)
    Ophthalmoscope for Disease Management
    Normal Fundus
    Ophthalmoscope for Disease Management
    Diabetic Retinopathy
    After 10 years, majority of
    diabetics will have some
    form of Diabetic
    Retinopathy
    After 25 years, 85% will
    Leading cause of
    blindness!
    Neovascularization
    (abnormal blood
    vessel growth)
    proliferative stage
    Hemorrhages & micro
    aneurysms (red Blots)
    Ophthalmoscope for Disease Management
    Hypertension
    Vessel walls become
    thickened and sclerotic
    Vessel light reflex looks
    like copper wiring
    When artery crosses
    vein, vein appears to
    disappear abruptly
    A/V nicking
    Hemorrhages
    Cotton-wool Spots
    (retinal ischemia)
    Ophthalmoscope for Disease Management
    Drusen or colloid
    bodies
    Creamy yellow Dots
    Blood vessel leakage
    of cholesterol-like
    deposits
    Age-related macular
    degeneration
    Also diabetes,
    hypertension
    Ophthalmoscope for Disease Management
    Papilledema
    Increased pressure in
    the central nervous
    system
    Increased intra-cranial
    pressure
    Head injuries -
    headache
    Engorged veins
    Disc elevation
    Ophthalmoscope for Disease Management
    Glaucoma - Cup/Disc Ratio
    Normal ratio: 0.1 - 0.5
    Symmetry between eyes very
    important.
    Suspect glaucoma when >0.5
    or asymmetrical.
    CUP: Inner, brighter
    yellow / higher reflex,
    recessed area.
    DISC: Outer, higher
    pallor, larger circular
    area of the nerve head.
    Ophthalmoscope for Disease Management
    Central Retinal Vein
    Occlusion
    Painless loss of vision
    The classical pizza
    thrown against the wall
    appearance of the fundus
    in this serious condition.
    Causes: hypertension,
    glaucoma,
    atherosclerosis, diabetes
    Ophthalmoscope for Disease Management
    Chorioretinal Scar
    (Toxoplasmosis)
    Congenital
    Early lesion heals and
    leaves scar in a cyst.
    Ophthalmoscope for Disease Management
    Detached Retina
    The thin wall of the retina
    is pulled away by the
    retracting of the vitreous
    gel.
    Ophthalmoscope for Disease Management
    Benign Choroidal
    Nevus
    Grey pigmented areas
    are a normal occurrence
    (like a mole or birthmark)

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