Ophthalmoscopy 13 111 Ophthalmoscopy

Indirect ophthalmoscopy is usually performed by the ophthalmologist (see p.306) and produces a laterally reversed image of the fundus. Less experienced examiners will prefer direct ophthalmoscopy. Here, the ophthalmoscope is held as close to the patient as possible (Fig. 1.13; see also Figs. 12.4b and c). Refractive errors in the patient's eye and the examiner's eye are corrected by selecting the ophthalmoscope lens required to bring the retina into focus. The examiner sees an erect, 16 power magnified image of the retina. The examination should be performed in a slightly darkened room with the patient's pupils dilated. Students should be able to identify the optic disk. In a normal eye, it is sharply defined structure with vital coloration (i.e., yellowish orange) at the level of the retina and may have a central excavation. The central vein lies lateral to the artery; venous diameter is normally 1.5 times greater than arterial diameter. Each vascular structure should be of uniform diameter, and there should be no vascular constriction where vessels overlap. A spontaneous venous pulse is normal; an arterial pulse is abnormal. Younger patients will have a foveal and macular light reflex, and the retina will have a reddish color (see Fig. 12.8). An ophthalmologist should be consulted if there are any abnormal findings.

— Ophthalmoscopy.

— Ophthalmoscopy.

Fig. 1.13 A direct ophthalmoscope produces an erect image of the fundus. The examiner views the patient's right eye with his or her own right eye so that their noses do not interfere with the examination. The examiner's right hand rests on the dial of the ophthalmoscope to bring the retina into focus.

Fig. 1.13 A direct ophthalmoscope produces an erect image of the fundus. The examiner views the patient's right eye with his or her own right eye so that their noses do not interfere with the examination. The examiner's right hand rests on the dial of the ophthalmoscope to bring the retina into focus.

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