Medically Fit For Exams
Medically Fit For Exams

Fundoscopy

  1. Introduce yourself, explain the procedure (bright light, coming close to their face, putting your hand on their face) and gain consent
  2. Turn the fundoscope on – press and push green button
  3. Ask the patient to focus on a point slightly up and to the opposite side of examination (left for right eye and vice versa)
  4. Choose a low brightness setting to start with
  5. Look through the fundoscope with the same side eye (left or right) as you are looking into, and hold the fundoscope with this hand. The other hand can be placed on the side of the patients head to guide you
  6. Look for the red reflex – at a distance of about 30cm, at a 45 degree angle to the nose
  7. ON MANIKINS ONLY – now turn off the fundoscope (to prevent glare)
  8. Move closer, using your other hand to gauge distance
  9. Adjust focus using your index finger – dial on the side of the fundoscope
  10. Look for the optic disc – find a large vessel and trace it
    • It should be round and pale with clear borders
    • Lack of clear borders (blurred, irregular) suggests papilloedema
    • Too pale suggests optic atrophy
    • A paler ring around the outside is disc cupping, such as in glaucoma
  11. Look for the macula – this is lateral to the optic disc, and has no blood vessels
    • Darkening or ‘stormy sunset’ can indicate problem such as retinal vein or artery occlusion
  12. Look at the vessels – veins are darker than arteries
    • AV (arteriovenous) nipping at vessel crossing points suggests hypertension
    • Silver wiring (some degree of wiring effect is normal in older adults, is abnormal when pale silver colour, ‘copper wiring’ is less severe) suggests hypertension
    • Haemmorhages around the vessels suggests hypertension (‘blot or flame’) or diabetes (‘dot and blot’)
    • Vessel tortuosity (looping and tortuous route from stiffened vessels) suggests hypertension or diabetes
    • Microaneurysms (small bulging areas of the arterioles) suggests diabetes
  13. Look at the rest of the retina – should be pink and clear
    • Haemmorhages
    • Cotton wool spots are a result of local ischaemia, suggest diabetes or hypertension
    • Hard exudates (lipids, proteins etc) suggest diabetes or hypertension (may be in a star shape around the macula)

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