II. 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')

III. 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:Disc >0.5 suggests Glaucoma
  3. Retinal Circulation
    1. Venous pulsations
  4. Macula
  5. Retinal Background

IV. 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

Images: Related links to external sites (from Bing)

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, ガンテイケンサ
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

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, モウマクショウガイ, モウマクショウガイNOS, ショウサイフメイノモウマクショウガイ, 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

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

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