Fundoscopy OSCE

1. Fundoscopy
UCLU MedSoc OSCE Station

2. First of all…
•Don’t panic! The actual examination itself is easy!
Secondly
•Know the slides and know the basic pathologies

3. Learn how it works-
they might ask you to
put it together before
you begin the station!
The ophthalmoscope

4. The examination
•WIPER
•Inspection
•Fundoscopy
•To finish…
Wash hands
Introduce yourself
Permission
‘Is it alright if look into your eyes today?
This will involve shining a bright light
into your eye. You can let me know if it
gets too uncomfortable. I will also have
to stand quite close in order to see
properly. Is this OK?
Expose
Reposition
Facing forward in a chair, ask to look at
a point in the corner of the room.

5. The examination
•WIPER
•Inspection
•Fundoscopy
•To finish…
Around the bed
Patient
General
(Briefly!)

6. The examination
•WIPER
•Inspection
•Fundoscopy
•To finish…
Ready the ophthalmoscope
Put it together, turn the light setting so it’s on a
white circle. Add the patient’s prescription to your
own before turning the number dial.
Comment on pupil dilation and then red reflex
What would you use? Differential for abnormal
red reflex?
Examine the retina
Comment on the disc- approach the patient (right
eye to right eye), aim your view towards the nasal
retina to find the optic disc. Colour, contours
and cupping.
Follow the arcades around, comment on
vasculature and 4 quadrants then finally
examine the macula by asking the patient to look
into the light.

8. What might you see?
The ophthalmology slides, obviously. If you haven’t got a
copy of them already, get one!
But it’s a good idea to know about the basic pathology of
each of the main conditions:
•Diabetic retinopathy
•Hypertensive retinopathy
•Glaucoma
•Retinal vein/artery occlusion
•Others signs e.g. papilloedema, optic atrophy

9. Background

10. Pre-proliferative

11. Proliferative

12. Diabetic retinopathy- making the diagnosis
•Background
-Microaneurysms, blot/flame haemorrhages, hard exudate
•Pre-proliferative
-As above (but in all 4 quadrants), cotton wool spots (soft exudate),
venous loops
•Proliferative
-New vessels, pre-retinal/vitreous haemorrhage, pre-retinal fibrosis,
tractional retinal detachment
•Maculopathy
-Can occur at any stage

14. Hypertensive retinopathy- making the
diagnosis
Grades:
1. To torture someone you:
2. Nip ‘em
3. Flame ‘em
4. Pap ‘em

16. Retinal vein/artery occlusion- making the
diagnosis
•RVO
-’Stormy sunset’, widespread haemorrhage
without other features, may be branch vein
occlusion
•RAO
-Retinal pallor, cherry red spot, may even see
cholesterol embolus

19. Optic atrophy
Glaucoma

20. Now watch us…

21. Now try it for yourselves…

22. Present these retinas:

23. Present these retinas:

24. Present these retinas:

25. Questions?