retinal examination& invistegation
TRANSCRIPT
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RetinaExamination&investigation
Dr_Mohamed ELShafie, assistant lecturer
Dr_Mohamed Ahmady, resident
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anatomy
• It is the senstive and inner most layer of the eye
• Derived from neural ectoderm• Extend from optic disc centrally to ora serrata
peripherally……..
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Minute amatimy
Histologically formed of ten
layers
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1. Retinal pigment epithelium2. Photoreceptors……(rods&cones)3. External limiting membrane4. Outer nuclear layer5. Outer plexiform layer6. Inner nuclear layer7. Inner plexiform layer8. Ganglion cell layer9. Nerve fiber layer10.Inner limiting membrane
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Blood supply
Outer 5 layers are AVASCULAR…..
Arterialcentral retinal artery• branch from ophthalmic artery• emerge from optic disc and immediately
divide into 4 branches……?
→FAZ….???
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Venouscentral retinal vein ….drain into cavernous sinus
Veins accompany the arteries and may cross each other……..
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Fundus examunation
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Direct ophthalmoscope• Uniocular• No steriopsis• Erect image• high magnification ×15• small field
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Indirect ophthalmoscope• Binocular vision• Streopsis• Inverted image• Low magnification ×5• Large field
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Slit lamp biomicriscopy
With contact lensGoldman 3 mirror lens
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With non contact lens• Biconcave(Hurby lens)
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• Biconvex lens (+60&+78&+90)
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Appearane of normal fundus
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How to test the center of the retina = macula = macular function tests• Form sense: VA
• Colour sense:
Clear media: ishihara colour book
Opaque media:Ophthalmoscope coloured filters + light source
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Some investigations
OCT
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Flourescein angiography
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Visual field examination
Conferentation test
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• Compares peripheral vision with a tester who has normal peripheral vision
• 2 ft. apart, eye level
• Tester & client cover opposite eyes
• Tester advances finger in the periphery– Superiorly ( 50 degrees )– Inferiorly ( 70 degrees )– Temporally ( 90 degrees )– Nasally ( 60 degrees )
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3_Perimetery
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Visual field defect
• scotoma blind spot is physiological -ve scotoma
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• Hemianopia involve one half of field(heterogenous& homonymous)
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Fundus picture of some diseases• Diabetic Retinopathy
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•VEDIO
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PRP
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Hypertensive Retinopathy
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CRAO&CRVO
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BRAO&BRVO
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Rhegmatogenous RD
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Tractional RD
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Retinitis pigmentosa
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papilloedema
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1ry optic atrophy
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Glaucomatous optic atrophy