Round tutorial for 4th year medical students Retinal Examination& Invistegation

1. Retina
Examination&investigation
Dr_Mohamed ELShafie, assistant lecturer
Dr_Mohamed Ahmady, resident

2. 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……..

3. Minute amatimy
Histologically
formed of ten
layers

4. 1. Retinal pigment epithelium
2. Photoreceptors……(rods&cones)
3. External limiting membrane
4. Outer nuclear layer
5. Outer plexiform layer
6. Inner nuclear layer
7. Inner plexiform layer
8. Ganglion cell layer
9. Nerve fiber layer
10.Inner limiting membrane

6. Blood supply
Outer 5 layers are AVASCULAR…..
Arterial
central retinal artery
• branch from ophthalmic artery
• emerge from optic disc and immediately
divide into 4 branches……?
→FAZ….???

7. Venous
central retinal vein ….drain into cavernous sinus
Veins accompany the arteries and may
cross each other……..

8. Fundus examunation

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

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

11. Slit lamp biomicriscopy
With contact lens
Goldman 3 mirror lens

13. With non contact lens
• Biconcave(Hurby lens)

14. • Biconvex lens (+60&+78&+90)

15. Appearane of normal fundus

16. 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

17. Some investigations
 OCT

18. Flourescein angiography

19. Visual field examination
Conferentation
test

20. • 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 )

21. 3_Perimetery

22. Visual field defect
• scotoma
blind spot is physiological -ve scotoma

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

25. Fundus picture of some diseases
• Diabetic Retinopathy

26. •VEDIO

27. PRP

28. Hypertensive Retinopathy

29. CRAO&CRVO

30. BRAO&BRVO

31. Rhegmatogenous RD

32. Tractional RD

33. Retinitis pigmentosa

34. papilloedema

35. 1ry optic atrophy

37. Glaucomatous optic atrophy