Historical Author / Public Domain (1917) Pre-1928 Public Domain

Fundus Examination Essentials

Diagnosis From Ocular Symptoms 1917 Chapter 71 2 min read

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The papilla is rarely affected after entering the retina. All other opacities except medullated nerve fibers along or over vessels are pathological. In young people, a bright border along a vessel changes with mirror movement, proving it's just light reflex. Each blood column should have smooth outlines; irregularity suggests wall issues. Light streaks should be uniform; any irregularity indicates vessel trouble. Retinal vessel sizes vary among individuals, making slight abnormalities hard to detect. We study the relative diameters of arteries and veins (3:4 ratio) and compare corresponding vessels in both eyes for deviations from normal. Cilioretinal vessels sometimes appear at the temporal periphery of the papilla, passing into the retina toward the macula. These can provide nutrition when central artery circulation is cut off but a cilioretinal vein is seldom seen. A venous pulse visible only in young people indicates potential sclerosis if spontaneous and retinal hemorrhages are present. An arterial pulse suggests imbalance between blood pressure and intraocular tension, common in glaucoma or abnormal conditions. Pigmentation on the papilla without other symptoms may be physiological but excessive pigment can obscure vision. The fundus background is usually uniform red with stippled appearance, deeper at macula and around papilla due to dense pigmentation. In tessellated fundus, choroidal vessels are visible due to insufficient pigment epithelium. Albinotic type shows narrow and sparse vessels, often in very light blondes or albinos. Macula lutea is a horizontally oval area with deeper hue than rest of fundus, darkest at center. Fovea centralis focuses light rays for distinct vision but not visible in adults. Light reflexes from young people include bright bands along blood vessels changing with head movement and Weiss's reflex ring near papilla (not pathological). Halo around macula is seen by indirect method. Abnormalities manifest through surface changes, indistinctness, color alterations, vessel irregularities, and choroidal visibility changes. Papilla swelling or excavation, vessel size and contour changes, background color variations, retinal elevations/depressions, haziness/opacity, spots of various colors indicate pathology. Diagnosis requires considering fundus picture, subjective symptoms, vision tests, refraction, visual fields, history, general health, congenital/acquired defects, lesion location (optic nerve, retina, choroid), and etiology.

Key Takeaways

Papilla analysis is crucial for detecting early signs of ocular disease.
Retinal vessel assessment helps identify potential circulatory issues and glaucoma risk.
Macula evaluation provides insights into central vision health.

Practical Tips

Use the 3:4 ratio to assess artery and vein diameters accurately.
Look for venous pulses in young individuals as an early sign of sclerosis.
Differentiate between physiological light reflexes and pathological symptoms carefully.

Warnings & Risks

Do not mistake physiological pigmentation on the papilla for serious pathology without other symptoms.
Be cautious when interpreting choroidal vessel visibility, distinguishing it from albinotic or tessellated fundus types.

Modern Application

While this chapter's diagnostic techniques are foundational and still relevant today, modern imaging technologies like OCT (Optical Coherence Tomography) offer more precise assessments of retinal layers and blood flow. However, understanding the basics described here remains crucial for initial triage and identifying when advanced diagnostics are necessary.