An ophthalmoscope is used to examine the retina and vitreous. Ophthalmoscopy aids visualization of the inside of the back of the eye including the retina, optic disc, choroid and blood vessels. It is often part of a routine eye examination. A direct ophthalmoscope is used for viewing the central retina. It is hand-held and powered with a light source. The instrument has to be adjusted constantly to focus on different structures within the eye. The light can be intense and disturbing. An indirect ophthalmoscope aids in examining the entire retina. This instrument is attached to the doctor's head and allows a clear view of the retina with a special lens. The patient may feel uncomfortable due to the intense light and pressure from the instrument.
Ophthalmoscopy is useful in detecting any changes in the retina due to diseases such as eye disease, diabetes, arteriosclerosis, high blood pressure or macular degeneration. Cataracts and other eye problems can be detected with an ophthalmoscope.
The patient's eyes are dilated so as to allow a good view of the insides of the eye. Some patients develop allergic reaction, vomiting, nausea and dizziness. This test is conducted in a darkened room where the patient is asked to look ahead at a distant spot. The eyes must be held steady without blinking. The ophthalmoscopy procedure may take just about 5 - 10 minutes.
Optic Disk Swelling
A doctor checks into the eye with an ophthalmoscope when there are regular complaints of headache, nausea or vomiting. This is to check for the appearance of the optic nerve and the blood vessels that pass through the eye. Swelling of the optic nerve is called Papilledema.
The optic nerve is a thick cord that connects the back of each eyeball and its retina to the brain. The cerebral spinal fluid protects the nerve between the brain and eye. Even if there is a slight increase in the pressure of this fluid, due to swelling in the brain, the optic nerve can get compressed around its whole circumference in a choking manner. The optic nerve can bulge whenever it develops inflammation on its own - causing Papilledema.
Such swelling of the optic nerve head can also be caused due to intracranial pressure. This could be due to an underlying brain tumor or brain infection such as abscess, meningitis or encephalitis. In fact many who are diagnosed with brain tumors exhibit Papilledema. Sometimes this can be caused due to high blood pressure.
Causes of Papilledema :
Symptoms of Papilledema :
Pseudo tumor cerebri or benign intracranial hypertension is one condition which can cause increased pressure in the cerebral spinal fluid. This is caused when the body makes too much spinal fluid. This is common in women especially who are obese and of child bearing age, and at such times when the body is adjusting to hormone changes such as pregnancy, the first menstrual period or menopause. It is better to go in immediately for neuro-imaging and MRI to check the cerebral cenous sinuses. A lumbar puncture could be done to check the opening pressure as well as CSF (cerebro spinal fluid) test, Fluorescein Angiography - an eye test specifically intended to check the blood flow in the Retina and Choroid, if there is diagnostic uncertainty. In some cases ultrasonography and Retinal Tomography may be used to get 3D data and image.
Although a swollen optic nerve tends to improve over a period of time, it may take months for complete restoration of normal vision. Doctors usually treat with intravenous steroid drugs but this process may have little effect on vision in some cases, although it may help to improve overall health.
Pediatric ophthalmology is a sub specialty of ophthalmology concerned with vision care and eye diseases in children. A pediatric ophthalmologist provides comprehensive care in diagnostic, treatment and management of infant vision and common childhood vision disorders. Surgery to correct ocular misalignment and double vision in children are also performed by a pediatric ophthalmologist. Pediatric ophthalmologists are physicians who have completed a three year residency in ophthalmology after the medical school and one year internship and one or two year fellowship in pediatric ophthalmology and strabismus. Pediatric ophthalmology fellowships are accredited by the American Association for Pediatric Ophthalmology and Strabismus in the US.
Role of a pediatric ophthalmologist in child vision care:
Tests conducted by pediatric ophthalmologist
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Collection of Pages - Last revised Date: July 1, 2020