OPHTHALMOSCOPE
PRESENTED BY,
Jeffrin.c,
B.Optom 2nd year,
Presentation on: optometric instruments
OPHTHALMOSCOPE
Also called as fundoscopy
Test allows to see inside fundus of eye and
other structures.
Done as a part of routine examination
Also for examining the interior structure of
eye.
PARTS OF OPHTHALMOSCOPE
handle
rheostat - controlling brightness
dioptre dial - madjusts the lens used to view
the eye.
viewing window - modifies light rays to
assist the user.
aperture dial - Make the light a bit dimmer.
large aperture - indilated pupil
.
small aperture - undilated pupil
green light pattern - ecentric viewing
read aperture - locating any retinal lesions
filters - red , green, blue
on \off button
brow rest - allows the eye doctor or
examiner to wear glasses while using the
ophthalmoscope
dioptre display - adjusts the lens used to
view the eye.
WORKING
First examiner dims the room light
Ask the patient to focus the fixed point on a
far wall
Examiner check the structure of eye using
ophthalmoscope
Then the examiner looking for healthy
retina
COMMON USES
Red filter - differentiate retinal and
choroidal lesions
Small aperture – examine fundus through
small pupil
Large aperture – examine fundus through
dilated fundus
TYPES OF
OPHTHALMOSCOPE
Distant direct ophthalmoscope
Direct ophthalmoscope
Indirect ophthalmoscope
DISTANT DIRECT
OPHTHALMOSCOPE
Distant direct ophthalmoscope
Gives idea about presence of opacity in the
cornea,lens and vitreous
It does not explains not only the presence of
opacity but also location,size and
movement of opacities in media.
principle
Utilizes combination of lenses,mirrors and
light sources to project an image of retina
onto the examiners eye
This optical system allows for magnification
and focusing retinal image.
uses of distant direct
ophthalmoscope
Opacities in media seen as dark spots in red
glow at pupillary area.
To detect retinal detachment
To differentiate between a mole on the iris
and hole in iris.
PROCEDURE
Make a patient sit comfortably at a distance
of half a meter from observer with fully
dilated .
Simple mydriatics are sufficient to dilate the
pupil.
Source of light kept about 25cm behind head
and laterally from the head of the patient
Plane mirror is used to reflect the light in the
dilated pupil while performing
ophthalmoscopy.
Concave mirror can be used but reflected
ray is very bright and sharp causing
inconvenience to patient
In a eye with clear media pupillary area
lightens up with a pink retinal glow without
any black spot.
If any presence of black spot in the pink
glow indicates presence of opacity.
Relative position of opacity can be
determined by parallax
Then the parallax is elicited to pupillary
plane,which corresponds to anterior lens
capsule
Patient is asked to move eye in different
meridian
If black sopt is stationary ,opacity is in lens
If black spot moves with movement of eye it
is in cornea
If opacity moves against the movement of
eye it is in vitreous
A grey reflex during performing distant
direct ophthalmoscope in pupillary area
instead of pink glow means retinal
deteachment, choroidal damage and
coloboma of choroids.
Dull reflex is seen in hazy vitreous,dense
PCIOL
Total absence of pupillary glow means
cataract,vitreous hemorrhage and
endophthalmitis
DIRECT
OPHTHALMOSCOPE
DEFINITION
Used to examine interior of eye, media
opacities and gross examination of
refractive condition of eye.
gross examination of refractive condition of
eye examined by bruckner test
principle
if the patient eye is emmetropic, light rays
emanting from a point in the fundus
emerges as a parallel beam
If the beam enetrs the pupil of an
emmetropic,observe the rays are focused
on the retina and an image is formed.
Characteristic of image
formed
Erect
Virutual
Magnification: 15 times magnified
structure
Explained in two ways
a)illumination system
b)viewing system
illumination system
Sends light into patient eye and consists of
- electric incandescent lamp
- two lenses
- a small 45 degree mirror
electric incandescent lamp :
light rays from lamp slightly converged
by lens 1 then lens 2 focuses the rays so that
image of lamp filament is produced on mirror
An aperture:
• The aperture between Lens 1 and Lens 2 allows
different shapes or colors of illumination.
• These apertures are mounted on a horizontally
oriented thumb-wheel so that different ones can
be used at different times.
A small, 45° mirror:
• Light rays from the mirror diverge, forming a
cone-shaped bundle of rays that enter the
subject’s eye.
• The bundle of rays passes through the cornea
and anterior chamber.
• Some of the rays are stopped by the iris, but
others pass through the pupil and then to the
retina.
Illumination system
allows the observer to see light reflected
from the subject’s eye
In the illumination system has flooded a
small circular area of the retina with light.
Light from this illuminated area is reflected in
all directions, but only some of the reflected
rays pass through the crystalline lens, pupil,
and cornea to the outside.
Those rays pass through the viewing
aperture and strike into observer retina and
allow to observe the patient retina.
Those rays pass through the viewing
aperture and strike into observer retina and
allow to observe the patient retina.
Magnification
The image formed during direct
ophthalmoscope is magnified, erect and
virtual, situated behind the observed eye.
The image formation depends upon the
dioptric power of the observed eye.
The dioptric power of the eye acts as a
strong convex sphere of +60D with short
focal length.
The magnification is similar to simple
magnifier/corneal loupe where the power of
the uniocular corneal loupe is +40D
It can be calculated by the formula:
M = D/4 = 60/4 = 15
where, M stands for magnification and D for
dioptric power of an emmetropic eye.
In case of myopia of 5D, this will be:
M = 64/5=16.25
In case of hypermtropia of 5D, this will be:
M = 54 /4 = 13.15
apertures available
1. Large & Small light source:
• The small light -pupil is very constricted .
• The large light -mydriatic eye drops to dilate. Most commonly in a dark .
2. Red free:
• Used to visualize the vessels and hemorrhages in better detail by improving
contrast. This setting will make the retina look black and white.
3. Slit beam:
• Used to examine contour abnormalities of the cornea, lens and retina.
4. Blue light:
• Some ophthalmoscopes have this feature that can be used to observe
corneal abrasions and ulcers after fluorescein staining.
5. Grid:
• Used to make rough approximations of relative distance between retinal
lesions.
• It also used in Visuoscopy to identify eccentric fixation.
Prerequisites
• Room should be semi dark room.
• Explain the patient about the procedure.
• Explain the patient that you need to go as
much as closer to patient eyes to see the
retina
Procedure
• The patient is asked to sit comfortably and
looking straight ahead.
• Patients right eye should be examined by the
observer with his or her right eye and left with the
left.
• The observer should reflect beam of light from the
ophthalmoscope into patient’s pupil.
• Once the red reflex is seen the observer should
move as close to the patient’s eye as possible.
• Once the retina focused the details should be
examined starting from disc,blood vessels, the four
quadrants of the general background and the macula
If patient or observer is not emmetropic
then rays may not focus on the retina. In
such case compensation lenses can be used
(Plus & minus lenses are incorporated) to
focus the rays on the observer retina.
Advantanges
Easy procedure as compared as IDO
Has greatest amount of magnification
Used in non dilated pupil
Disadvantages
Stereoscopic view is not possible
Limited field of view
INDIRECT
OPHTHALMOSCOPE
One of the most widely used optical device
to examine the fundus and perform retinal
surgery .It is most unavoidable tool in
retinal surgery
Types
Two types of IDO
1)INDIRECT OPHTHALMOSCOPE
- No more in use
2)binocular indirect ophthalmoscope
-either attached to headband or
spectacle mounted
procedure
Dark room preferred whenever possible
Make a patient to lie in supine position in a
chair
The examiner should move around the
patient gaining a full 360 degree transverse
of fundus.the examiner should place the
ophthalmoscope on the head
Focus the light on the outstreched thumb to
set the IPD
Ete pieces are close to the pupil.
Examiner should illuminate the pupillary
area
Interpose the condensor lens close to the
eye about 2 cms and centre the lens on to
the pupil Lens should be held more convex
side towards the examiner
Pull pack the lens away from patient eyes
An image obtained ,filling the lens,the
fundus may be examined by moving around
the patient.
characterisatics of image:
- real
-inverted
-magnified
scleral indenter
Examiner should choose a type of depressor
tool feels comforts to hold
Examiner should gently place the probe on
the outside of the lid
Examiner move the probe into the fold of
the lid
If it is difficult , indentation can be done
applying probe to sclera without intervening
lid but topical anesthesia should be used to
make patient comfort
Advantages
Large field of view
Stereopsis
Vitreousa can be examined easily
Lesser distorsion of retinal image
Disadvantage
Impossible to small pupil
More uncomfort to patient
Less magnification
filters
Green – nerve fibre,blood vessels
Red - subtle pigmentary abnormalities
Blue - angioscopy
Yellow – reduces photophobia
Differences between DO AND
IDO
THANK YOU
