Sales Training Feb 14 - Medicine

Anatomy and Physiology and Techniques of Examination

examples of abnormalities

Steps for Using theOphthalmoscope ( continued )

converges nor diverges light. Keep your finger on the edge of the lens disc so you can turn the disc to focus the lens when you examine the fundus. ◗◗ Hold the ophthalmoscope in your right hand and use your right eye to examine the patient’s right eye ; hold it in your left hand and use your left eye to examine the patient’s left eye . This keeps you from bumping the patient’s nose and gives you more mobility and closer range for visualizing the fundus. At first, you may have difficulty using your nondominant eye, but this will abate with practice. ◗◗ Hold the ophthalmoscope firmly braced against the medial aspect of your bony orbit, with the handle tilted laterally at about a 20-degree slant from the vertical. Check to make sure you can see clearly through the aperture. Instruct the patient to look slightly up and over your shoulder at a point directly ahead on the wall. ◗◗ Place yourself about 15 inches away from the patient and at an angle 15 degrees lateral to the patient’s line of vision . Shine the light beam on the pupil and look for the orange glow in the pupil—the red reflex . Note any opacities interrupting the red reflex.

Examiner at 15-degree angle frompatient’s line of vision, eliciting red reflex

Absence of a red reflex suggests an opacity of the lens (cataract) or possibly of the vitreous. Less commonly, a detached retina or, in children, a retinoblastoma may obscure this reflex. Do not be fooled by an artificial eye, which has no red reflex.

◗◗ Now, place the thumb of your other hand across the patient’s eyebrow. (This technique helps keep you steady but is not essential.) Keeping the light beam focused on the red reflex, move in with the ophthalmoscope on the 15-degree angle toward the pupil until you are very close to it, almost touching the patient’s eyelashes. Try to keep both eyes open and relaxed, as if gazing into the distance, to help minimize any fluctuating blurriness as your eyes attempt to accommodate. You may need to lower the brightness of the light beam to make the exami- nation more comfortable for the patient, avoid hippus (spasm of the pupil), and improve your observations. *Some clinicians like to use the large round beam for large pupils, and the small round beam for small pupils. The other beams are rarely helpful. The slitlike beam is sometimes used to assess elevations or concavities in the retina, the green (or red-free) beam to detect small red lesions, and the grid to make measurements. Ignore the last three lights and practice with the large or small round white beam.

C h a p t e r 7 |  The Head and Neck

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8/24/12 9:00 PM