{"id":1647,"date":"2010-12-06T14:15:01","date_gmt":"2010-12-06T14:15:01","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/examination-direct-funduscopy\/"},"modified":"2023-09-26T17:01:24","modified_gmt":"2023-09-26T16:01:24","slug":"examination-direct-funduscopy","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-eyes-and-vision\/the-posterior-eye-segment-direct-funduscopy\/examination-direct-funduscopy\/","title":{"rendered":"Examination: Direct Funduscopy"},"content":{"rendered":"<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>Preparation For The Examination: Pupil Dilation<\/strong><\/span><\/span><\/h3>\n<p><span style=\"color: #003366;\">Prior to the examination, <span style=\"color: #33cccc;\"><strong>dilate<\/strong><\/span> the patient\u2019s pupil by dropping <span style=\"color: #33cccc;\"><strong>mydriatics<\/strong><\/span> into the eye. Ask the patient to wait for <span style=\"text-decoration: underline;\">15 to 30 minutes<\/span>, until the mydriatics have an <em>effect<\/em>.<\/span><\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/123324253?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<p><span style=\"color: #003366;\">For the purpose of this program, the examination using a <span style=\"color: #33cccc;\"><strong>hand-held funduscope<\/strong><\/span> will be described.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; When the pupil is sufficiently <span style=\"text-decoration: underline;\">dilated<\/span>, ask patient to sit on the examination chair.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; If the patient wears <span style=\"color: #33cccc;\"><strong>contact lenses<\/strong><\/span>, ask what <span style=\"text-decoration: underline;\">strength<\/span> the correction is.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; <\/span><span style=\"color: #003366;\">Glasses must be <span style=\"text-decoration: underline;\">taken off<\/span>.\u00a0<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; The <span style=\"color: #33cccc;\"><strong>correction<\/strong><\/span> is adjusted using the <span style=\"color: #33cccc;\"><strong>optic disc<\/strong><\/span> of the funduscope. This allows the examiner to conduct the examination with an unaccommodated eye.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; Sit on a stool and adjust the height so the eyes are at the same level as those of the patient.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; Position yourself so that you <span style=\"text-decoration: underline;\">do not<\/span> have to <em>lean forward<\/em> during the examination.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; Lean backwards <em>slightly<\/em>, to see the eye in front of you through the funduscope.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; During the examination, hold the funduscope in front of your <span style=\"text-decoration: underline;\">right eye<\/span> when examining the <span style=\"color: #33cccc;\"><strong>patient\u2019s<\/strong><\/span> <span style=\"text-decoration: underline;\">right eye<\/span>, and vice versa for the <span style=\"color: #33cccc;\"><strong>left eye<\/strong><\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; If you have <span style=\"color: #33cccc;\"><strong>profound dominance<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>amblyopia<\/strong><\/span> of one of your eyes, you can proceed by asking the patient to lie down on the examination table. Stand at the head end of the examination table, behind the patient, and conduct the examination whilst standing over the patient and holding the funduscope in front of your <span style=\"color: #33cccc;\"><strong>dominant<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>good eye<\/strong><\/span> <em><strong>[Figure 73]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1642\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-73.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-73.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-73-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 73<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">&#8211; Ask the patient to look into the distance with the other eye.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; Move your head and funduscope in a manner that allows you to reach a distance where the patients\u2019 pupil lights up <span style=\"color: #33cccc;\"><strong>red<\/strong><\/span> <em><strong>[Figures 74, 75]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1643\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-74.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-74.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-74-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 74<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1644\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-75.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-75.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-75-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 75<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">&#8211; Zoom in to the <span style=\"color: #33cccc;\"><strong>red patch<\/strong><\/span>. You will see the <span style=\"text-decoration: underline;\">outlines<\/span> of the <span style=\"color: #33cccc;\"><strong>blood vessels<\/strong><\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; You will first see the <span style=\"color: #33cccc;\"><strong>papilla<\/strong><\/span>, from where the <span style=\"text-decoration: underline;\">vascular tree<\/span> originates. If not, follow the vessels in the direction of the sites where the <span style=\"text-decoration: underline;\">branches merge<\/span>. Eventually, you will reach the papilla.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; Assess the <span style=\"color: #33cccc;\"><strong>papilla<\/strong><\/span>. Pay attention to the depth of the <span style=\"color: #33cccc;\"><strong>cup<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>cup<\/strong><\/span>\/<span style=\"color: #33cccc;\"><strong>disc ratio<\/strong><\/span> (<em>normally 3\/10 to 6\/10<\/em>). Assess the <span style=\"color: #33cccc;\"><strong>colour<\/strong><\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; Starting from the <span style=\"text-decoration: underline;\">papilla<\/span>, follow the <span style=\"text-decoration: underline;\">vascular tree<\/span> in the <span style=\"color: #33cccc;\"><strong>four directions<\/strong><\/span>. You will see vessels running in <span style=\"color: #33cccc;\"><strong>parallel<\/strong><\/span>: the <em>thicker,<\/em> <em>darker<\/em> <span style=\"color: #33cccc;\"><strong>retinal vein<\/strong><\/span> together with the <em>narrower<\/em>, <em>lighter<\/em> <span style=\"color: #33cccc;\"><strong>retinal artery<\/strong><\/span>. Assess the <span style=\"color: #33cccc;\"><strong>course<\/strong><\/span> of the vessels (<em>slightly meandering, extremely wiry, extremely straight<\/em>), the <span style=\"color: #33cccc;\"><strong>branching<\/strong><\/span> of the vessels (<em>V-shaped, sharp or blunt, T-shaped<\/em>), <span style=\"color: #33cccc;\"><strong>obstructions<\/strong><\/span> in the <span style=\"color: #33cccc;\"><strong>trajectory<\/strong><\/span> of the vessels &#8211; causing bloodstream blockage, dilations of the vessels, crossing of the vessels.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; When examining the <span style=\"color: #33cccc;\"><strong>retina<\/strong><\/span>, look through the <span style=\"color: #33cccc;\"><strong>vitreous body<\/strong><\/span>. Observe whether the vessels grow in from the retina into the vitreous body. Look for any <span style=\"text-decoration: underline;\">bleeding<\/span> or <em>white<\/em>, <em>cloudy<\/em> <em>structures<\/em>.<\/span><\/p>\n<p><span style=\"color: #003366;\">&#8211; Return to the papilla and ask the patient to look into the light. You will be able to see the <span style=\"color: #33cccc;\"><strong>macula<\/strong><\/span>. This is located just <em>temporally<\/em> from the papilla. Characteristic of this structure is the <span style=\"text-decoration: underline;\">lack<\/span> of any vessel structures. In the middle, you will see a <em>small<\/em>, <em>bright<\/em> <span style=\"color: #33cccc;\"><strong>spot<\/strong><\/span> light up. In general, the colour of the macula is a bit <span style=\"text-decoration: underline;\">more intense<\/span> than that of the surrounding retina <em><strong>[Figure 76]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1645\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-76.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-76.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-76-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 76<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1646\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-77.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-77.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-77-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 77: Image Seen Through A Funduscope.<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Preparation For The Examination: Pupil Dilation Prior to the examination, dilate the patient\u2019s pupil by dropping mydriatics into the eye. Ask the patient to wait for 15 to 30 minutes, until the mydriatics have an effect. Procedure For the purpose of this program, the examination using a hand-held funduscope will be described. &#8211; When the [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[50],"tags":[134],"class_list":["post-1647","post","type-post","status-publish","format-standard","hentry","category-the-posterior-eye-segment-direct-funduscopy","tag-the-examination-of-the-eyes-and-vision"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Examination: Direct Funduscopy - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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