Ophthalmoscopy

Answer 1

Definition

Ophthalmoscopy is an examination of the back part of the eyeball (fundus), which includes the retina, optic disc, choroid, and blood vessels.

Alternative Names

Funduscopy

How the test is performed

There are different types of ophthalmoscopy.

• Direct ophthalmoscopy
• Indirect ophthalmoscopy
• Slit-lamp ophthalmoscopy

Direct ophthalmoscopy: You will be seated in a darkened room. The health care provider performs this common exam by shining a beam of light through the pupil using an instrument called an ophthalmoscope. An ophthalmoscope is about the size of a flashlight. It allows the examiner to view the back of the eyeball.

Indirect ophthalmoscopy: You will either lie or sit in a semi-reclined position. The health care provider holds your eye open while shining a very bright light into the eye using an instrument worn on the head. (The instrument looks like a miner's light.) Some pressure may be applied to the eyeball using a small, blunt tool. You will be asked to look in various directions.

For information on slit-lamp ophthalmoscopy, see the article: Slit-lamp exam

Opthalmoscopy examination takes about 5 and 10 minutes.

How to prepare for the test

Indirect ophthalmoscopy and slit-lamp ophthalmoscopy are performed after eye drops are placed to widen (dilate) the pupils. Direct ophthalmoscopy can be performed with or without dilation of the pupil.

The eye drops may make it hard to focus your eyes for several hours. You should arrange to have someone else to drive after the examination. Wearing sunglasses or tinted lenses will help make your dilated pupils more comfortable.

You should tell the health care provider if you:

• Are allergic to any medications
• Are taking any medications
• Have glaucomaor a family history of glaucoma

How the test will feel

The bright light will be uncomfortable, but the test is not painful.

You may have a brief sensation of seeing images after the light shines in your eyes. The light is brighter with indirect ophthalmoscopy, so the sensation of seeing after-images may be greater.

Pressure put on the eyeball during indirect ophthalmoscopy by may be slightly uncomfortable, but should not be painful.

If eyedrops are used, they may produce a brief stinging sensation when placed in the eyes and an unusual taste in the mouth.

Why the test is performed

Ophthalmoscopy is done as part of a routine physical or complete eye examination.

It is used to detect and evaluate symptoms of retinal detachment or eye diseases such as glaucoma.

Ophthalmoscopy may also be done if you have signs or symptoms of high blood pressure, Diabetes, or other diseases that affect the blood vessels.

Normal Values

The retina, blood vessels, and the optic disc should appear normal.

What abnormal results mean

Abnormal results may be due to eye diseases such as a detached retina, optic nerve problems, macular degeneration, and changes caused by glaucoma. High blood pressure can also be detected.

Additional conditions under which the test may be performed:

• CMV retinitis
• Diabetes
• Hypertensive retinopathy
• Macular degeneration
• Melanoma of the eye

What the risks are

The test itself involves no risk. The dilating eye drops may rarely produce nausea, vomiting, dryness of the mouth, flushing, dizziness, or an attack of narrow-angle glaucoma. If the latter is suspected, drops generally are not used.

Special considerations

Ophthalmoscopy is considered to be 90-95% accurate and can detect the early stages and effects of many serious diseases.

References

Yanoff M, Duker JS, Augsburger JJ, et al. eds. Ophthalmology. 2nd ed. St. Louis, Mo: Mosby; 2004:1461-1462.

Ruamviboonsuk P, Wongcumchang N, Surawongsin P, Panyawatananukul E, Tiensuwan M. Screening for diabetic retinopathy in rural area using single-field, digital fundus images. J Med Assoc Thai. 2005 Feb;88(2):176-80.

Answer 2

Definition

Ophthalmoscopy is an examination of the back part of the eye (fundus), which includes the retina, optic disc, choroid, and blood vessels.

Alternative Names

Funduscopy

How the test is performed

There are different types of ophthalmoscopy.

• Direct ophthalmoscopy -- You will be seated in a darkened room. The health care provider performs this common exam by shining a beam of light through the pupil using an instrument called an ophthalmoscope. An ophthalmoscope is about the size of a flashlight. It has a light and several different tiny lenses that allow the examiner to view the back of the eyeball.
• Indirect ophthalmoscopy -- You will either lie or sit in a semi-reclined position. The health care provider holds your eye open while shining a very bright light into the eye using an instrument worn on the head. (The instrument looks like a miner's light.) The health care provider views the back of the eye through a hand-held lens held close to your eye. Some pressure may be applied to the eyeball using a small, blunt probe. You will be asked to look in various directions.
• Slit-lamp ophthalmoscopy -- You will sit in a chair with the instrument placed in front of you. You will be asked to rest your chin and forehead on a support to keep your head steady. The health care provider will use the microscope part of the slit lamp and a tiny lens placed close to the front of the eye. The health care provider can see about the same with this technique as with indirect ophthalmoscopy, but with higher magnification.

The opthalmoscopy examination usually takes about 5 to 10 minutes.

How to prepare for the test

Indirect ophthalmoscopy and slit-lamp ophthalmoscopy are performed after eye drops are placed to widen (dilate) the pupils. Direct ophthalmoscopy and slit-lamp ophthalmoscopy can be performed with or without the pupil dilated.

The eye drops may make it hard for you to focus your eyes for several hours. You should arrange to have someone else drive you after the examination. Wearing sunglasses or tinted lenses will help make your dilated pupils more comfortable.

You should tell the health care provider if you:

• Are allergic to any medications
• Are taking any medications
• Have glaucomaor a family history of glaucoma

How the test will feel

The bright light will be uncomfortable, but the test is not painful.

You may briefly see images after the light shines in your eyes. The light is brighter with indirect ophthalmoscopy, so the sensation of seeing after-images may be greater.

Pressure on the eye during indirect ophthalmoscopy by may be slightly uncomfortable, but it should not be painful.

If eyedrops are used, they may sting briefly when placed in the eyes. You may also have an unusual taste in your mouth.

Why the test is performed

Ophthalmoscopy is done as part of a routine physical or complete eye examination.

It is used to detect and evaluate symptoms of retinal detachment or eye diseases such as glaucoma.

Ophthalmoscopy may also be done if you have signs or symptoms of high blood pressure, diabetes, or other diseases that affect the blood vessels.

Normal Values

The retina, blood vessels, and the optic disc should appear normal.

What abnormal results mean

Abnormal results may be seen on ophthalmoscopy with any of the following conditions:

• CMV retinitis
• Diabetes
• Glaucoma
• High blood pressure
• Macular degeneration
• Melanoma of the eye
• Optic nerve problems
• Retinal tear or detachment

What the risks are

The test itself involves no risk. The dilating eye drops may rarely cause:

• An attack of narrow-angle glaucoma
• Dizziness
• Dryness of the mouth
• Flushing
• Nausea
• Vomiting

If glaucoma is suspected, drops usually are not used.

Special considerations

Ophthalmoscopy is considered to be 90-95% accurate. It can detect the early stages and effects of many serious diseases.

References

Colenbrander A. Principles of Ophthalmology. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 63.

Volk D. Aspheric Lenses. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 50.

Miller D, Thall EH, Atebara NH. Ophthalmic instrumentation. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, MO: Mosby Elsevier;2008:chap 2.10.

American Academy of Ophthalmology Preferred Practice Patterns Committee, Preferred Practice Pattern Guidelines. Comprehensive Adult Medical Eye Evaluation. San Francisco, CA: American Academy of Ophthalmology. 2010. Accessed January 17, 2011.

Reviewed By

Review Date: 02/10/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, Unviersity of Washington School of Medicine; and Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.