Professional Documents
Culture Documents
Topical anesthesia is given and dilatate the lacrimal punctum. Anel needle inserted in the
punctum and canaliculi lakrima. Spraying is done with normal saline. Asked whether the patient
feels fluid in the throat or seen whether the swallowing reflex occurs in patients. If its appear, it
means good excretory function of the lacrimal system. if its not appear, then there is a blockage
of the nasolacrimal duct.
Funduscopy Examination
1. Keep both yours and the person's eyes
2. Have the patient focus on a distant object
3. Look at right fundus with your right eye
4. Ophthalmoscope should be close to your eyes. Your head and the scope should move
together
5. Set the lens opening at +8 to +10 diopters. With the ophthalmoscope 12-15 inches from
the patient's eye, check for the red reflex and for opacities in lens or aqueous.
6. While adjusting the diopter setting, approach the patient more closely and systematically
inspect the disc, noting the color, shape, margins and cup-to-disc ratio.
7. Inspect the vessels, noting obstruction, caliber and arterial/venous ratio.
8. Note the presence of arterial/venous nicking and arterial light reflex.
9. Check the background by inspecting for pigmentation, hemorrhages and hard or soft
exudates.
10. Next, try to identify the macula.
o Have the patient look at light
Medications
o Tropicamide 0.5% - 1% (Mydriacyl)
Shorter acting
Contra-indications to use
o Shallow anterior chamber OR angle-closure Glaucoma
o Following pupillary signs after Head Injury
o Iris supported intraocular lens implantation
We will find :
Disc
o margins are sharp
o color: yellowish orange to creamy pink
o shape: round or oval
o Cup to disc ratio: less than half
Vessels
o AV ratio
o AV crossing: no indentation
o No arterial light reflex
Fundus background
o No exudates or hemorrhages
o color : red to purplish
Macula
Pathological Optic Cupping : Note cup-to-disc ratio at least 0.8 (physiologic limit of 0.5).
Chronic hypertension stiffens and thickens arteries. At AV crossing points (arrow) arteries indent
and displace veins.
Roth Spot
Pale-centered hemorrhage. Caused by several conditions, not only bacterial endocarditis.