Procedure
Begin the examination with the penlight/funduscope in a ‘full light’ setting [Figure 58].
Figure 58
Assess the intactness of the conjunctiva, sclera and cornea, and the possibility of conjunctival injection in one of these structures. If the latter is the case, move the conjunctiva over the eye globe with a cotton bud, dampened with physiological saline solution. Distinguish if the conjunctival injection is present in the sclera or conjunctiva.
If the visible vessels are located in the conjunctiva, they will move along across the eye globe. If the vessels are in the sclera, they will remain stationary. If the former is true, there will often be conjunctival injection or redness visible during inspection of the tarsal conjunctiva.
Ask the patient to look up, down, left and right. If you observe damage to the conjunctiva, sclera or cornea, or identify a foreign object in one of these structures; this will need to be investigated further with the slit-shaped light of the funduscope [Figure 59].
Engage it by using the handle located at the base of the funduscope. Illuminate the eye at approximately 45°. Keep it at a distance that makes the stripe-shaped light smallest when it reaches the eye. Start the examination in the lateral corner of the eye and slowly move the light across the eye globe. This determines the exact location, size and depth of the damage or the foreign object.
Figure 59