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Funduscopic Exam
Aka: Funduscopic Exam, Ophthalmoscopy, Fundoscopy, Retinal Exam, Retina Exam, Retinal Disease, Retinal Disorder, Retinopathy
- See Also
- Retinal Anatomy
- Funduscopic Changes in Hypertension
- Eye Ultrasound
- Eye Exam
- Diabetic Retinopathy
- Retinopathy of Prematurity
- Preparation: Pupil Dilation
- See Mydriatics
- Tropicamide 0.5% - 1% (Mydriacyl)
- Onset: 20-40 minutes
- Duration: 4-8 hours in most cases (may last as long as 24 hours)
- Blue eyes more sensitive, lasts longer
- Start with 0.5% concentration
- Phenylephrine hydrochloride 2.5% (Ak-Dilate, Mydfrin)
- Onset: 30-60 minutes
- Duration: 3-5 hours
- Contraindications to dilation
- Shallow anterior chamber OR angle-closure Glaucoma
- Diagnostic exam Mydriatic use is safe (see Mydriatic)
- Following pupillary signs after Head Injury
- Iris supported intraocular lens implantation
- (square/hexagonal pupil 'sputnik')
- Exam: Protocol
- Red Reflex
- Optic Disc
- Clarity of disc (evaluation for Papilledema)
- Cup Disc Ratio
- Ratio of horizontal diameter of the cup to disc
- Abnormal Cup:Disc >0.5 suggests Glaucoma
- Retinal Circulation
- Venous pulsations
- Macula
- Retinal Background
- Findings
- Increased Intracranial Pressure
- Papilledema
- Absent venous pulsations
- Vitreous Hemorrhage
- Retina with overlying reddish haze
- Black Reflex
- Macular Degeneration
- Gray-Green sub-Retinal membrane
- Retinal Artery Occlusion
- Retina appears pale-gray due to Retinal edema
- Central Macula (fovea) with cherry-red spot on white-yellow background
- Constricted arterioles
- Box-Carring of Retinal vessels
- Retinal vessels with interrupted columns of blood appear as train box cars
- Hollenhorst Plaques (emboli)
- "Glistening orange yellow flakes"
- Represent fragmented emboli at arteriole bifurcation
- Retinal Vein Occlusion
- Optic disc edema
- Retinal veins with tortuous dilation
- Blood streaked Retina (esp. in ischemic type)
- Diffuse Retinal Hemorrhages radiating from optic disc ("Blood and thunder Retina")
- Glaucoma
- General
- Focal thinning of neural rim
- Nerves at edge of cup and edge of disc
- Thinning seen at temporal (lateral) disc margin
- Superficial Hemorrhage overlying disc edge
- Cloudy Cornea (acute Glaucoma)
- Diagnostic changes
- Symmetrically enlarged cup-to-disc ratio >0.5 or
- Cup-to-disc ratio difference between eyes >0.2 or
- Significantly asymmetric cup in one eye
- Diabetic Retinopathy
- Nonproliferative Retinopathy
- Retinal veins dilated
- Cotton Wool exudates or spots
- Hard exudates
- Macular edema
- Intraretinal Hemorrhages
- Microaneurysms
- Proliferative Retinopathy
- Neovascularization
- Preretinal Hemorrhages
- Vitreous Hemorrhages
- Vascular fibrosis
- Subarachnoid Hemorrhage
- Blood in center of disc
- Methanol Intoxication
- Choked disc with engorged veins