Fundoscopic Examination

A fundoscopic examination (also called ophthalmoscopy or fundus examination) allows the doctor to directly view the structures at the back of the eye, including the retina, optic nerve, and blood vessels. This is the only place in the body where blood vessels and nerve tissue can be directly observed.

What Is Examined

Optic Nerve (Optic Disc)

• Color (pink = healthy, pale = atrophy)
• Margins (sharp vs. blurred)
• Cup-to-disc ratio (enlarged in glaucoma)
• Swelling (disc edema, papilledema)

Retina

• Overall appearance
• Hemorrhages
• Exudates
• Pigmentary changes
• Lesions or tumors

Blood Vessels

• Arteries and veins
• Ratio and crossings
• Narrowing or dilation
• Emboli or plaques

Macula

• Central vision area
• Drusen or deposits
• Swelling or holes

Methods of Examination

Direct Ophthalmoscopy

• Handheld device held close to patient
• Magnified, upright view
• Limited field of view
• Good for optic nerve and macula
• Often used in primary care

Indirect Ophthalmoscopy

• Light source worn on examiner's head
• Handheld lens held in front of patient's eye
• Wider field of view
• Image is inverted
• Better for peripheral retina
• Requires more skill and dilation

Slit Lamp Biomicroscopy

• Using slit lamp with special lens
• Very detailed, magnified view
• Excellent for optic nerve and macula
• Standard in ophthalmology offices

Dilated vs. Undilated

Dilated Examination

• Eye drops widen the pupil
• Much better view of retina
• Essential for complete examination
• Takes 15-30 minutes for drops to work
• Causes light sensitivity and blurred near vision for hours

Undilated Examination

• Limited view, especially of periphery
• May miss important findings
• Sometimes used for quick screening
• Optic nerve often still visible

What Conditions Can Be Detected

Eye Conditions

• Glaucoma (optic nerve cupping)
• Macular degeneration
• Diabetic retinopathy
• Retinal detachment
• Optic neuritis/optic atrophy
• Papilledema

Systemic Conditions

• Diabetes (retinopathy)
• Hypertension (retinal vessel changes)
• Elevated intracranial pressure
• Blood disorders
• Infections
• Some cancers

In Neuro-Ophthalmology

Fundoscopic exam is crucial for evaluating:

• Optic neuritis—may show disc swelling
• Papilledema—bilateral disc swelling
• Ischemic optic neuropathy—disc edema, pallor
• Optic atrophy—pale disc
• Giant cell arteritis
• Signs of elevated or low intracranial pressure

What to Expect

Before the Exam

• May have dilating drops placed
• Wait 15-30 minutes for dilation

During the Exam

• Room lights dimmed
• Bright light shone into eye
• Asked to look in different directions
• Brief discomfort from light

After the Exam

If dilated:

• Light sensitivity for 4-6 hours
• Difficulty reading up close
• Bring sunglasses
• May need someone to drive

Related Tests

• Fundus photography—photographs of fundus
• OCT—detailed cross-section imaging
• Fluorescein angiography—blood vessel imaging