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Understand the utility of the direct ophthalmoscope
Identify key anatomical structures visible with the direct ophthalmoscope
Learn the parts and settings of the direct ophthalmoscope
Learn the exam technique of the direct ophthalmoscope
Understand the utility of the direct ophthalmoscope
The direct ophthalmoscope allows you to look into the back of the eye to look at the health of the retina, optic nerve, vasculature and vitreous humor. This exam produces an upright image of approximately 15 times magnification.
Wash your hands.
Introduce yourself to the patient and explain what you are going to do.
Position the patient so that the ophthalmoscope is held directly at the level of the patient’s eye.
Turn on the ophthalmoscope and set the light to the correct aperture.
Dim the lights.
Instruct the patient to focus on an object straight ahead on the wall.
To exam the patient’s RIGHT eye, hold the ophthalmoscope in your RIGHT hand and use your RIGHT eye to look through the instrument.
Place your left hand on the patient’s head and place your thumb on their eyebrow.
Hold the ophthalmoscope about 6 inches from the eye and 15 degrees to the right of the patient.
Find the red reflex.
Move in closer, staying nasally until you see the optic nerve.
Rotate the diopter lens until the optic nerve comes into focus.
The farsighted eye requires more plus/green number lenses.
The nearsighted eye requires more minus/red number lenses.
Measure the cup to disc ratio.
Scan slightly up, down, right and left to look at the vessels.
Move out temporally to find the macula and fovea.
Repeat the same technique on the other eye.
References:
“Examination of the optic nerve at the slit-lamp biomicroscope with a handheld lens – EyeWiki.” Accessed July 17, 2018. http://eyewiki.aao.org/Examination_of_the_optic_nerve_at_the_slit-lamp_biomicroscope_with_a_handheld_lens
“3.5V Standard Ophthalmoscope.” https://www.welchallyn.com/en/products/categories/physical-exam/eye-exam/ophthalmoscopes–traditional-direct/35v_standard_ophthalmoscope.html
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