Physical examination maneuver
Ophthalmoscopy
How to Perform
Coaxial ophthalmoscope: Darken the room, set the ophthalmoscope to a round white light, and ask the patient to fixate on a distant point. Use your right eye and hand to examine the patient's right eye and your left for the left. Look through the ophthalmoscope and shine the light onto the pupil and view the red reflex from about 15 inches away and slightly lateral, then move in close and follow a retinal vessel back to the optic disc. Examine the disc (margins, color, cup), the retinal vessels, the retinal background in four quadrants, and finally the macula by asking the patient to look at the light.
Wide-field direct ophthalmoscope: Darken the room, select the standard round white light and ask the patient to fixate on a distant point. Use your right eye and hand for the patient's right eye and your left for the left. Stand slightly lateral to the eye being examined. Hold the wide-field direct ophthalmoscope approximately 6 inches away, align its light with the pupil until the red reflex is visible, and advance directly toward the eye while keeping the pupil centered. Gently seat the eyecup against the patient's orbit without pressing on the globe, then adjust the focus wheel until the fundus is clear. The optic disc may come directly into view; otherwise, follow a retinal vessel centrally as it increases in caliber. Examine the disc (margins, color, and cup-to-disc ratio), retinal vessels, and retinal background in all four quadrants, gently pivoting the instrument or directing the patient's gaze as needed. Examine the macula last by asking the patient to look briefly at the light.