retinal examination& invistegation

RetinaExamination&investigation

Dr_Mohamed ELShafie, assistant lecturer

Dr_Mohamed Ahmady, resident

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……..

Minute amatimy

Histologically formed of ten

layers

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

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….???

Venouscentral retinal vein ….drain into cavernous sinus

Veins accompany the arteries and may cross each other……..

Fundus examunation

Direct ophthalmoscope• Uniocular• No steriopsis• Erect image• high magnification ×15• small field

Indirect ophthalmoscope• Binocular vision• Streopsis• Inverted image• Low magnification ×5• Large field

Slit lamp biomicriscopy

With contact lensGoldman 3 mirror lens

With non contact lens• Biconcave(Hurby lens)

• Biconvex lens (+60&+78&+90)

Appearane of normal fundus

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

Some investigations

OCT

Flourescein angiography

Visual field examination

Conferentation test

• 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 )

3_Perimetery

Visual field defect

• scotoma blind spot is physiological -ve scotoma

• Hemianopia involve one half of field(heterogenous& homonymous)

Fundus picture of some diseases• Diabetic Retinopathy

•VEDIO

PRP

Hypertensive Retinopathy

CRAO&CRVO

BRAO&BRVO

Rhegmatogenous RD

Tractional RD

Retinitis pigmentosa

papilloedema

1ry optic atrophy

Glaucomatous optic atrophy