Physical Exam

Ophthalmoscopy

also known as Fundoscopy

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Video coming September 2026

How to Perform

Darken the room 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. Find 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.

How to Interpret

Diabetic Retinopathy

Hemorrhages and exudates

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Limited

Endocarditis

Roth spots

Rule in

Not helpful

Rule out

Not helpful

Evidence:Limited

Glaucoma

Cup-to-disc ratio increase

Rule in

Very helpful

Rule out

Somewhat helpful

Evidence:Limited

Increased Intracranial Pressure

Loss of venous pulsations

Rule in

Minimally helpful

Rule out

—

Evidence:Limited

Papilledema

Rule in

—

Rule out

Minimally helpful

Evidence:Limited

References

Mitchell A, Baig AA, Kanj U, Rodrigues D, Painter S, Abbott J. Papilloedema: a highly specific predictor of raised intracranial pressure in a complex neurosurgical paediatric cohort. Childs Nerv Syst. 2024 Feb;40(2):463-469. doi:10.1007/s00381-023-06137-2. PMID: 37665341.
Wong SH, White RP. The clinical validity of the spontaneous retinal venous pulsation. J Neuroophthalmol. 2013 Mar;33(1):17-20. doi:10.1097/WNO.0b013e3182622207. PMID: 22801353.
Mowatt G, Burr JM, Cook JA, Siddiqui MAR, Ramsay C, Fraser C, Azuara-Blanco A, Deeks JJ; OAG Screening Project Group. Screening tests for detecting open-angle glaucoma: systematic review and meta-analysis. Invest Ophthalmol Vis Sci. 2008 Dec;49(12):5373-5385. doi:10.1167/iovs.07-1501. PMID: 18614810.
Ahsan S, Basit A, Ahmed KR, Ali L, Shaheen F, Ulhaque MS, Fawwad A. Diagnostic accuracy of direct ophthalmoscopy for detection of diabetic retinopathy using fundus photographs as a reference standard. Diabetes Metab Syndr. 2014 Apr-Jun;8(2):96-101. doi:10.1016/j.dsx.2014.04.015. PMID: 24907174.
van der Vaart TW, Heerschop LL, Bouma BJ, Freudenburg W, Bonten MJM, Prins JM, van der Meer JTM. Value of diagnosing immunological phenomena in patients with suspected endocarditis. Infection. 2023;51:705-713. doi:10.1007/s15010-022-01954-0. PMID: 36355270.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.