Funduscopic Exam

Aka: Funduscopic Exam, Ophthalmoscopy, Fundoscopy, Retinal Exam, Retina Exam, Retinal Disease, Retinal Disorder, Retinopathy, Neuroretinal Rim, Optic Disk, Optic Disc, Optic Nerve Head, Optic Papilla, Optic Cup, Optic Cup to Disc Ratio

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II. Anatomy

  1. See Retinal Anatomy
  2. Optic Disc (Optic Nerve Head, Optic Papilla)
    1. Pink to white oval disc at the posterior globe where the Retinal Ganglion cell axons exit the eye and form the Optic Nerve
    2. This portion of the Retina is devoid of light sensitive photoreceptors
  3. Optic Cup (Physiologic Cup)
    1. Funnel shaped depression at the center of the Optic Disc
    2. Paler than the surrounding Neuroretinal Rim
    3. In Glaucoma, the cup enlarges (cupping) as the rim thins, resulting in an increased cup to disc ratio (>0.3)
  4. Neuroretinal Rim
    1. Outer, pink portion of the Optic Disc that surrounds the Optic Cup
    2. Neuroretinal Rim contains nerve fibers and glial cells
    3. Injury to the Retinal axons of the results in cell loss and thinning of the rim
    4. Glaucoma-related pressure induces Retinal axon injury and Neuroretinal Rim thinning

III. Preparation: Pupil Dilation

  1. See Mydriatics
  2. Tropicamide 0.5% - 1% (Mydriacyl)
    1. Onset: 20-40 minutes
    2. Duration: 4-8 hours in most cases (may last as long as 24 hours)
    3. Blue eyes more sensitive, lasts longer
    4. Start with 0.5% concentration
  3. Phenylephrine hydrochloride 2.5% (Ak-Dilate, Mydfrin)
    1. Onset: 30-60 minutes
    2. Duration: 3-5 hours
  4. Contraindications to dilation
    1. Shallow anterior chamber OR angle-closure Glaucoma
      1. Diagnostic exam Mydriatic use is safe (see Mydriatic)
    2. Following pupillary signs after Head Injury
    3. Iris supported intraocular lens implantation
      1. (square/hexagonal pupil 'sputnik')

IV. Exam: Protocol

  1. Red Reflex
  2. Optic Disc
    1. Clarity of disc (evaluation for Papilledema)
    2. Cup Disc Ratio
      1. Ratio of horizontal diameter of the cup to disc
      2. Abnormal Cup to Disc Ratio >0.3 to 0.5 suggests Glaucoma
  3. Retinal Circulation
    1. Venous pulsations
  4. Macula
  5. Retinal Background

V. Findings

  1. Increased Intracranial Pressure
    1. Papilledema
    2. Absent venous pulsations
  2. Vitreous Hemorrhage
    1. Retina with overlying reddish haze
    2. Black Reflex
  3. Macular Degeneration
    1. Gray-Green sub-Retinal membrane
  4. Retinal Artery Occlusion
    1. Retina appears pale-gray due to Retinal edema
    2. Central Macula (fovea) with cherry-red spot on white-yellow background
    3. Constricted arterioles
    4. Box-Carring of Retinal vessels
      1. Retinal vessels with interrupted columns of blood appear as train box cars
    5. Hollenhorst Plaques (emboli)
      1. "Glistening orange yellow flakes"
      2. Represent fragmented emboli at arteriole bifurcation
  5. Retinal Vein Occlusion
    1. Optic Disc edema
    2. Retinal veins with tortuous dilation
    3. Blood streaked Retina (esp. in ischemic type)
      1. Diffuse Retinal Hemorrhages radiating from Optic Disc ("Blood and thunder Retina")
  6. Glaucoma
    1. General
      1. Focal thinning of neural rim
        1. Nerves at edge of cup and edge of disc
        2. Thinning seen at temporal (lateral) disc margin
      2. Superficial Hemorrhage overlying disc edge
      3. Cloudy Cornea (acute Glaucoma)
    2. Diagnostic changes
      1. Symmetrically enlarged cup-to-disc ratio >0.5 or
      2. Cup-to-disc ratio difference between eyes >0.2 or
      3. Significantly asymmetric cup in one eye
  7. Diabetic Retinopathy
    1. Nonproliferative Retinopathy
      1. Retinal veins dilated
      2. Cotton Wool exudates or spots
      3. Hard exudates
      4. Macular edema
      5. Intraretinal Hemorrhages
      6. Microaneurysms
    2. Proliferative Retinopathy
      1. Neovascularization
      2. Preretinal Hemorrhages
      3. Vitreous Hemorrhages
      4. Vascular fibrosis
  8. Subarachnoid Hemorrhage
    1. Blood in center of disc
  9. Methanol Intoxication
    1. Choked disc with engorged veins

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Related Studies

Ontology: Ophthalmoscopy (C0029090)

Definition (MSH) Examination of the interior of the eye with an ophthalmoscope.
Definition (CSP) examination of the interior of the eye through an ophthalmoscope, an instrument consisting of lenses, light source and pierced concave mirror that directs reflected light through the pupil.
Concepts Diagnostic Procedure (T060)
MSH D009887
ICD9 16.21
SnomedCT 53524009, 164739003, 370998006, 164733002, 141906001, 274798009
CPT 1012822
HL7 FS
LNC LP149841-1
English Ophthalmoscopies, Fundoscopy, Fundoscopy NOS, fundoscopic examination, fundoscopic exam, fundoscopic examination (physical finding), ophthalmoscopy (procedure), fundoscopy, ophthalmoscopy, funduscopy, Clinical evaluation of optic fundoscopy (procedure), Fundoscopic evaluation, Fundoscopy NOS (procedure), Ophthalmoscopy Procedures, Funduscopy, Ophthalmoscopic examination, Ophthalmoscopy (procedure), Ophthalmoscopy, NOS, Ophthalmoscopic examination, NOS, Fundoscopy, NOS, Funduscopy, NOS, Clinical evaluation of optic fundoscopy, Ophthalmoscopy
Italian Esame del fundus, Oftalmoscopia
Japanese 眼底検査, ｶﾞﾝﾃｲｹﾝｻ
Swedish Oftalmoskopi
Czech oftalmoskopie, Fundoskopie
Finnish Silmäntähystys
Russian OFTAL'MOSKOPIIA, ОФТАЛЬМОСКОПИЯ
French Examen du fond d'oeil, Ophtalmoscopie
Spanish fundoscopia, fondo de ojo, evaluación clínica de fundoscopia óptica, evaluación clínica de fundoscopia óptica (procedimiento), fundoscopia, SAI, fondo de ojo, SAI (procedimiento), fondo de ojo, SAI, oftalmoscopia, examen oftalmoscópico, oftalmoscopia (procedimiento), Fundoscopia, Oftalmoscopía
Croatian OFTALMOSKOPIJA
Polish Wziernikowanie dna oka, Oftalmoskopia
Hungarian Fundoszkópia
Norwegian Oftalmoskopi
Portuguese Fundoscopia, Oftalmoscopia
Dutch fundoscopie, Oftalmoscopie
German Fundoskopie, Ophthalmoskopie
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Optic Disk (C0029127)

Definition (NCI) A portion of the retina at which the axons of the ganglion cells exit the eyeball to form the optic nerve. No light-sensitive photoreceptors are contained within this portion of the retina.
Definition (NCI_CDISC) A portion of the retina at which the axons of the ganglion cells exit the eyeball to form the optic nerve. No light-sensitive photoreceptors are contained within this portion of the retina. (NCI)
Definition (MSH) The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve.
Definition (CSP) intraocular portion of the optic nerve formed by fibers converging from retina and appearing as a pink to white disk.
Concepts Body Part, Organ, or Organ Component (T023)
MSH D009898
SnomedCT 14782001, 81016008
English Disk, Optic, Disks, Optic, Optic Disks, Optic Papilla, Optic Papillas, Papilla, Optic, Papillas, Optic, Head, Optic Nerve, Heads, Optic Nerve, Nerve Head, Optic, Nerve Heads, Optic, Optic Nerve Head, Optic Nerve Heads, optic disk, Pars intraocularis nervus optici, Discus nervi optici, Pars intraocularis (Nervus opticus), Intra-ocular part of optic nerve, discs optic, disk optic, optic nerve head, head nerve optic, optic disc, disc optic, optic disks, Structure of intraocular part of optic nerve (body structure), OPTIC DISC, Second Cranial Nerve, Intraocular part of optic nerve, Optic disc, Optic nerve colliculus, Optic nerve head, Optic papilla, OD - Optic disc, Optic disc structure (body structure), Optic disc structure, Structure of intraocular part of optic nerve, Optic Disk, Optic Disc
Swedish Synnervspapill
Czech papila nervi optici, discus nervi optici, terč zrakového nervu, papila zrakového nervu, disk zrakového nervu
Finnish Näköhermon nysty
Russian SLEPOE PIATNO, ZRITEL'NOGO NERVA DISK, ZRITEL'NOGO NERVA SOSOK, ЗРИТЕЛЬНОГО НЕРВА ДИСК, ЗРИТЕЛЬНОГО НЕРВА СОСОК, СЛЕПОЕ ПЯТНО
Japanese 盲点, 視神経乳頭, 視神経円板
Italian Testa del nervo ottico, Papilla ottica, Disco ottico
Latvian Redzes nerva disks
Spanish estructura del disco óptico (estructura corporal), estructura de la papila óptica (estructura corporal), estructura de la papila óptica, estructura del disco óptico, porción intraocular del nervio óptico, estructura de la porción intraocular del nervio óptico, estructura de la porción intraocular del nervio óptico (estructura corporal), cabeza del nervio óptico, colículo del nervio óptico, disco óptico, papila óptica, Disco Óptico, Cabeza del Nervio Óptico, Papila Óptica
Polish Brodawka nerwu wzrokowego, Krążek nerwu wzrokowego, Tarcza nerwu wzrokowego
Norwegian Optikuspapille, Synsnervepapille, Papilla nervi optici
French Papille optique
German Optikuspapille, Papilla nervi optici, Sehnervenpapille
Dutch Discus nervi optici, Papilla nervi optici
Portuguese Cabeça do Nervo Óptico, Disco Óptico, Papila Óptica
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Retinal Diseases (C0035309)

Definition (MEDLINEPLUS)

The retina is a layer of tissue in the back of your eye that senses light and sends images to your brain. In the center of this nerve tissue is the macula. It provides the sharp, central vision needed for reading, driving and seeing fine detail.

Retinal disorders affect this vital tissue. They can affect your vision, and some can be serious enough to cause blindness. Examples are

  • Macular degeneration - a disease that destroys your sharp, central vision
  • Diabetic eye disease
  • Retinal detachment - a medical emergency, when the retina is pulled away from the back of the eye
  • Macular pucker - scar tissue on the macula
  • Macular hole - a small break in the macula that usually happens to people over 60
  • Floaters - cobwebs or specks in your field of vision

NIH: National Eye Institute
Definition (NCI) Any disease or disorder of the retina.
Definition (NCI) An abnormal structure or function of the retina and its associated tissues.
Definition (NCI_CTCAE) A disorder involving the retina.
Definition (CSP) pathologic condition of the innermost of the three tunics of the eyeball or retina.
Concepts Disease or Syndrome (T047)
MSH D012164
ICD9 362.9
ICD10 H35.9
SnomedCT 193430004, 267715002, 35426003, 399625000, 29555009
English Disease, Retinal, Diseases, Retinal, Retinal Diseases, Unspecified retinal disorder, RETINAL DISORDER, retina disorder, RETINOPATHY, Retinal disorder NOS, Retinal disorder, unspecified, RETINAL DIS, retinopathy (diagnosis), retinopathy, Disorder retinal, Retinopathy N0S, Retinopathy NOS, Retinal Diseases [Disease/Finding], diseases retinal, retinopathies, Disorder;retina, disease retinal, retinal diseases, disorders retina, disorders retinal, retinal disease, retinal disorder (diagnosis), Retinal Disorders, Retinal disorder NOS (disorder), Retinopathies, Retinopathy, Retinal disorder, Retinal disease, Retinal disorder (disorder), Retinopathy (disorder), disease (or disorder); retina, retina; disorder, Retinopathy, NOS, Retinal disease, NOS, Retinal disorder, NOS, Retinal Disease, Retinal Disorder, retinal disorder
French RETINOPATHIE, Trouble de la rétine, Rétinopathie SAI, Trouble rétinien SAI, Affection rétinienne non précisée, TROUBLE RETINIEN, Rétinopathie, Trouble rétinien, Rétinopathies, Maladies de la rétine, Maladies rétiniennes
Italian Retinopatia, Patologia retinica, Alterazione retinica, Disturbo non specificato della retina, Patologia retinica NAS, Retinopatia NAS, Malattie della retina
Dutch retinopathie NAO, niet-gespecificeerde retina-aandoening, retina-aandoening NAO, aandoening retina, Retinopathie, aandoening; retina, retina; aandoening, Aandoening van retina, niet gespecificeerd, retina-aandoening, retinopathie, Retinaziekte, Retinaziekten, Ziekte, retina-, Ziekten, retina-
German unspezifische Erkrankung der Retina, Erkrankung der Retina NNB, Retinopathie NNB, Affektion der Netzhaut, nicht naeher bezeichnet, RETINAERKRANKUNG, RETINOPATHIE, Retinopathie, Erkrankung der Retina, Netzhauterkrankungen, Retinakrankheiten
Portuguese Retinopatia NE, Afecção da retina, Afecção da retina NE, Alteração da retina NE, ALTERACAO DA RETINA, RETINOPATIA, Retinopatia, Anomalia da retina, Doenças Retinianas
Spanish Retinopatía NEOM, Trastorno retiniano, Trastorno retiniano NEOM, Trastorno retiniano no especificado, RETINA, TRASTORNO, RETINOPATIA, trastorno de la retina (trastorno), trastorno retiniano (trastorno), trastorno retiniano, trastorno de la retina, trastorno retiniano, SAI (trastorno), trastorno retiniano, SAI, enfermedad retiniana, retinopatía (trastorno), retinopatía, Alteración retiniana, Retinopatía, Enfermedades de la Retina
Japanese 詳細不明の網膜障害, 網膜症, 網膜障害ＮＯＳ, 網膜症ＮＯＳ, 網膜障害, ﾓｳﾏｸｼｮｳ, ﾓｳﾏｸｼｮｳｶﾞｲ, ﾓｳﾏｸｼｮｳｶﾞｲNOS, ｼｮｳｻｲﾌﾒｲﾉﾓｳﾏｸｼｮｳｶﾞｲ, ﾓｳﾏｸｼｮｳNOS
Swedish Näthinnesjukdomar
Finnish Verkkokalvon sairaudet
Russian SETCHATKI BOLEZNI, СЕТЧАТКИ БОЛЕЗНИ
Czech Nespecifikovaný defekt sítnice, Porucha sítnice, Onemocnění sítnice NOS, Retinopatie NOS, Onemocnění sítnice, Retinopatie, nemoci retiny, nemoci sítnice, retina - nemoci
Korean 상세불명의 망막 장애
Croatian RETINALNE BOLESTI
Polish Choroby siatkówki
Hungarian Retinabetegség, Retina betegség, k.m.n., Retinopathia, Retinopathia k.m.n., Nem meghatározott retina betegség
Norwegian Retinale sykdommer, Sykdommer i retina, Netthinnesykdommer, Retinasykdommer
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Optic disc cup (C0278233)

Concepts Finding (T033)
SnomedCT 247222003
Spanish copa de papila óptica, borramiento del contorno de la excavación de la papila óptica, excavación de la papila óptica, excavación de la papila óptica (entidad observable), borramiento del contorno de la excavación de la papila óptica (entidad observable), Optic disc cup (observable entity), Optic disc cup
English Optic disc cup, Optic disc cup (observable entity)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Retinopathies NEC (C0852383)

Concepts Disease or Syndrome (T047)
Italian Retinopatie NCA
Japanese 網膜症ＮＥＣ, ﾓｳﾏｸｼｮｳNEC
Czech Retinopatie NEC
Hungarian Retinopathiák m.n.o.
English Retinopathies NEC
Portuguese Retinopatias NC
Spanish Retinopatía NCOC
Dutch retinopathieën NEG
French Rétinopathies NCA
German Retinopathien ANE
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Optic nerve cup/disc ratio (C0855712)

Concepts Diagnostic Procedure (T060)
Italian Rapporto fovea/disco del nervo ottico
Japanese 視神経乳頭陥凹／乳頭比, ｼｼﾝｹｲﾆｭｳﾄｳｶﾝｵｳﾆｭｳﾄｳﾋ
Czech Poměr exkavace k terči zrakového nervu
English Optic nerve cup/disc ratio
Hungarian Látóideg cup/disc arány
Portuguese Relação disco/escavação do nervo óptico
Spanish Proporción excavación/disco del nervio óptico
Dutch oogzenuw cup/disc ratio
French Rapport cupule/papille
German Exkavation der Sehnervpapille
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Neuroretinal rim finding (C1271413)

Concepts Finding (T033)
SnomedCT 392163005
English Neuroretinal rim finding (finding), Neuroretinal rim finding
Spanish anillo neurorretiniano - hallazgo (hallazgo), anillo neurorretiniano - hallazgo
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Examination of retina (C3241977)

Concepts Diagnostic Procedure (T060)
SnomedCT 141191002, 276489008, 163992007, 274798009
English retinal exam, examination of retina (physical finding), examination of retina, Examination of retina, Examination of retina (procedure)
Spanish examen de la retina (procedimiento), examen de la retina
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Examination

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