Binocular (Stereoscopic

acuity) test
Ophthalmologic examination

• 1. For examination of the right eye, sit or stand at the patient’s side.
• 2. Select “o” on the illuminated lens dial of the ophthalmoscope and start with
small
• aperture.
• 3. Take the ophthalmoscope and start in the right hand and hold it vertically infront
of your
• own right eye with the light beam directed toward the patient and place your
right index
• finger on the edge of the Lens dial so that you will be able to change lenses
easily if
• necessary.
• 4. Dim room lights. Instruct the patient to look straight ahead at a distant object.
Cont…

• 5. Position the ophthalmoscope about 6 inches (15 cm) in front and

slightly to the right (25°) of the patient and direct light beam to the
pupil. A “red reflex” should appear as you look through the pupil

• *RED REFLEX: The red reflex refers to the reddish-orange reflection of

light from the back of the eye, or fundus, observed when using
an ophthalmoscope. The reflex relies on the transparency of optical
media (tear film, cornea, aqueous humor, crystalline lens, vitreous
humor) and reflects off the fundus back through media into the aperture
of the opthalmoscope. The red reflex is considered abnormal if there is
any asymmetry between the eyes, dark sports, or white reflex.
Red reflex
Cont…

If it is not focused clearly, rotate lenses into the aperture with your index finger until
the optic disc is as clearly visible as possible. The hyperopic, or farsighted, eye requires
more “plus” (black numbers) sphere for clear focus of the fundus; the myopic, or
nearsighted, eye requires “minus” (red numbers) sphere for clear focus.

•CHECK FUNDUS BACKGROUND:

• For exudates or hemorrhages
• color (e.g. red to purplish)
5. Rest the left hand on the patient’s forehead and hold the upper lid of the eye near the eyelashes
with the thumb. While the patient holds his fixation on the specified object, keep the “reflex” in
view and slowly move toward the patient. The optic disc should come into view when you are
about 1½ to 2 inches (3-5 cms) from the patient.

**The optic disc or optic nerve head is the point of exit for ganglion cell axons leaving the eye.
Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in
each eye. The ganglion cell axons form theoptic nerve after they leave the eye.

*Optic nerve-head examination is probably the most important step in the diagnosis of
glaucoma and is also extremely important in monitoring patients with established
glaucoma.

CHECK FOR:
• The margins
• Color (e.g. yellowish orange to creamy pink)
• shape: round or oval
• Cup to disc ratio (e.g. less than half)
What to look for in the examination:

• Now examine the disc for clarity of outline, color, elevation, and condition of
the vessels. Follow each vessel as far to the periphery as you can.
• What: Follow the trajectory of the vessels on the optic disc to assess the contour of the
neuroretinal rim. Look for bayoneting, baring, nasalization, and narrowing of the blood
vessels.
6. Let the patient look at the light of the ophthalmoscope, which will automatically place the macula in the
full view. Examine for abnormalities in the macular area. The red-free filter facilitates viewing of the center
of the macula or the fovea.

***The macula or macula lutea is an oval-shaped pigmented area near the center of the retina
of the human eye and some other animalian eyes.
***macula is responsible for the central, high-resolution, color vision that is possible in good
light; and this kind of vision is impaired if the macula is damaged

CHECK FOR:

• macula is location and distance temporal to

disc
• Note presence of vessels around

• Pigmentation
7.To examine the extreme periphery, instruct the patient to:
a. Look up for examination of the superior retina
b. Look down for examination of the inferior retina
c. Look temporally for examination of the temporal retina
d. Look nasally for examination of the nasal retina
9. To examine the left eye, repeat the procedure outlined above except that
you hold the ophthalmoscope in the left hand; stand at the patient’s left side
and use your left eye.
CLINICAL CORRELATION
COMMON PATHOLOGIES OF THE EYE

NORMAL FUNDUS CENTRAL RETINAL VEIN OCCLUSION

Disc: Outline clear; central

Disc: Virtually obscured by
physiological cup is pale
edema and hemorrhages
Retina: Normal red/orange color,
Retina: Extensive blot retinal
macula is dark; avascular area
hemorrhages in all quadrants to
temporally
periphery
Vessels: Arterial/venous ratio 2
Vessels: Dilated tortuous
to 3; the arteries appear a bright
veins; vessels partially
red, the veins a slightly purplish
obscured by hemorrhages
colour
HYPERTENSIVE RETINOPATHY INFERIOR BRANCH RETINAL ARTERY OCCLUSION
DUE TO EMBOLUS

Disc: Outline clear Disc: Prominent embolus at retinal artery bifurcation

Retina: Exudates and flame hemorrhages
Vessels: Attenuated arterial reflex
Retina: Inferior retina shows pale, milky edema;
superior retina is normal
Vessels: Inferior arteriole tree greatly attenuated and
irregular; superior vessel is normal
HYPERTENSIVE RETINOPATHY (ADVANCED NONPROLIFERATIVE DIABETIC RETINOPATHY
MALIGNANT)

Disc: Elevated, edematous disc; blurred disc margins
Retina: Prominent flame hemorrhages surrounding
vessels near disc border
Vessels: Attenuated retinal arterioles
Disc: Normal
Retina: Numerous scattered exudates and hemorrhages
Vessels: Mild dilation of retinal veins
 PROLIFERATIVE DIABETIC RETINOPATHY MACULAR DRUSEN (COLLOID BODIES)

Disc: Net of new vessels growing on disc surface Disc: Normal

Retina: Numerous hemorrhages, new vessels at superior Retina: Extensive white drusen of the retina
disc margin Vessels: Normal
Vessels: Dilated retinal veins