Funduscopic Examination
PURPOSE
The main purpose of optic funduscopy in the neurologic examination is to look for swelling of the optic disc. In the clinical context in which subarachnoid hemorrhage is a consideration, another purpose of funduscopy is to look for retinal hemorrhages.
WHEN TO PERFORM THE FUNDUSCOPIC EXAMINATION
An attempt at visualization of the optic fundus should be performed on all patients as part of a standard neurologic examination.
NEUROANATOMY OF THE FUNDUSCOPIC EXAMINATION
The optic nerves are formed from the axons of retinal neurons that converge to exit the eye and send visual information back to the brain. The optic disc, also called the optic nerve head, is the portion of the optic nerve that can be visualized when looking in the optic fundus. The optic discs are located in a slightly medial position within the retina; this is important to remember when trying to visualize the optic disc.
The subarachnoid space that surrounds the brain and spinal cord also extends into the optic nerves. Therefore, processes that increase the intracranial pressure can also extend their pressure along the optic nerves, which may be visualized as swelling of the optic nerve head (papilledema).
EQUIPMENT NEEDED FOR THE FUNDUSCOPIC EXAMINATION
An ophthalmoscope.
HOW TO EXAMINE THE OPTIC FUNDUS
Begin by preparing the ophthalmoscope. Set the ophthalmoscope to 0 diopters, the optimal initial setting for most patients and physicians. Set the light of the ophthalmoscope so that it produces a white circle of light.
Ask the patient to look straight ahead at a distant spot in a dim room. It is helpful to show the patient a specific spot on the wall in front of the patient to fixate on (or a spot on the ceiling if the patient is lying in bed). Being in a dim room, rather than a dark room, better allows the patient to see the spot and helps with fixation. Ask the patient to try to keep fixating on that spot without moving his or her eyes.
Hold the ophthalmoscope to your eye. Look through the ophthalmoscope with your right eye to assess the patient’s right eye, and look through the ophthalmoscope with your left eye to examine the patient’s left eye.
While holding the ophthalmoscope to your eye and shining it into your patient’s pupil, bring the ophthalmoscope in from the temporal side of the eye so that you are aiming slightly toward the medial side of the retina.
Bring the ophthalmoscope in toward the patient as you continue to try to visualize the optic disc. Generally by this time you should be close to the patient. To avoid striking the patient’s eye with the ophthalmoscope, it is helpful to hold your index finger slightly outward so that this rests against the patient’s cheek, using your other fingers to grip the ophthalmoscope tightly.Related posts:
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