Systolic <120

Diastolic <80

Van Herick Angles (4+,3+,2+ are OK)

Tonometry

Blood Pressure

Permission from attending doctor

Systolic>120

Diastolic >80

Systolic >140

Diastolic >90

systolic >160

diastolic > and 100

antichoinergic (parasympatholytic)

• stings when put it in
•  can increase  IOP

anticholinergic (parasympatholytic) blocks the iris sphincter.

0.5%, 1.0%

sympatomimetic (alpha receptor agonist).

Stimulates the DILATOR muscle.

2.5% and 10%

sting upon instillation, toxic dermatitis, conjunctival hyperemia, discomfort,

elevated IOP

(2.5% and10%)

drowsiness,

disorientation,

visual hallucinations.

• limits systemic absorption

• put pressure in the inferior naal parts of the lids- probably for about 1 minute

Px give informed consent,  educated on side effects,

name of drop and %,

time,

which eye,

name of who instilled the drops,

check off for consent,

why did they not get dilated if not.

vitreous,

posterior pole,

equatorial retina,

peripheral retina.

1. headband (or spectacle mount): crown strap placement and comfort
2. optical viewing system: PD adjustment-- thumb method
3. Illumination system (rheostat): light adjustment- intensity, spot size & size placement

high dioptric power plus lens,

double aspheric, antireflective multi-layered coating,

various designs.

visual field INCREASES

magnification DECREASES

the larger field of fiew.

1. Light beams into pt eye,
2. Reflective observation beams from retina -->
3. beams focused to a viewable aerial image by condensing lens

• real image,

• magnified image,

• image reversed left to right,

• image inverted top to bottom,

• Image is located between examiner and condensing lens.
• image viewed through BIO oculars

1. glasses off, dilated, reclined (pt head parallel to floor, adjust neck support)
2. raise/lower chair to examiner hips, condensing lens in dominant hand.
3. More convex surface twrd examiner (white-ringed edge of lens toward px)
4. tell them where to fixate,  examiner stand opposite quadrant being examined, no-dominant hand to hold open eyelids, keep both eyes open.
5. light beam into pupil, see red reflex, put condensing lens into light beam, brace and pull back with pupil reflex centered within lens, retinal image should fill condensing lens completely.
6. Be arms length away 18-20"

• Stereopsis

• Large field of view

• Bright illumination of retina,

• Minimal peripheral retina distortion.

Must dilate pupil,

pt discomfort with glare and light,

examiner must compensate for inverted/reversed image,

less magnification,

initial learning curve before examiner is comfort with skill/

Straight line connecting BIO oculars,

aerial image,

optical center of condensing lens,

center of pupil,

fundus area being examined.

what do you do for unwanted reflections?

recheck alignment of whole system,

align reflections on front and back of lens,

make sure condensing lens is proper distance from patient.

• As condensing lens is pulled away from patient's face, make sure reflections are centered and aligned.

• Rest fingers on pt face to stabilize lens.

• Continue to mantain lens parallel to the eye piece.

remove the BIO +2.00 lens,

clean condensing lens,

if views clearer without the +2.00 then AE or CI

let pt break and blink, give artificial tears,

photosensitivity (reduce rheostat)

limit continous light on one are of retin to 35-40 secs max!

• maintain working distance throughout.

• hold px lids to maximize my view.

• have px turn or adjust head if nose or brow are interfering with view.

closer to posterior pole,

posterior pole is 60-70% of fundus

optic nerve,

macula & fovea,

central retinal artery and vein,

superior & inferior arcades

• red octopus like appearance,
•  merging of choroidal venous tributaries under the retinal vessels.

• best seen in lighter pigmented fundi, in darker fundus: background is darker so harder to see,

• there are 4-15 per eye,

• it is different sizes and orientation in people

where in the peripheral retina are the long posterior ciliary arteries and nerves (LPCN & LPCA)

• Located at 3  & 9 o'clock

• These arteries and nerves emerge at equator and run anteriorly
•  divide the fundus into superior and inferior halves.

run perpendicular to ora serrata,

pigment mottled lines,

• age-related band of mottled pigment,

• located posterior to the ora serrata,
• represents attachment of posterior vitreous to retina

it is the end of chroid and retina,

1. first invert,
2. second reverse

OR

rotate the image and condensing lens by 180 degreesa

• view peripheral views first.
• view macular and nerve last.

size of lesion, in terms of disc diopters,

location of lesion (DD used to estimate actual fundus distances)

Color,

depth/elevation,

borders

flat &intact to ora 360 deg or flat 360.

Record pertinent negatives like -DR, -HTN Ret, -RD

doctor pivots body left or right depending on where view needs to move.

px does contant gazefor nasal, temporal,

Get normal static view of any portion of retina,

pupil acts as center of rotation,

keep system aligned: BIO oculars--> image--> optical center of condensing lens--> center of pupil--> fundsus area behing examined.

obtain overlapping views to see the whole retina:

inspect entire quadrant in one fluid view. you do this by moving in/out and left and right while px gaze stays steady.