Fundoscopic exam
Formal Definition
Ophthalmoscopic examination of the posterior segment of the eye (retina, optic disc, macula, fovea, and posterior pole) using a direct or indirect ophthalmoscope; critical for detecting papilledema (elevated intracranial pressure), hypertensive retinopathy, diabetic retinopathy, retinal artery/vein occlusion, and other systemic or ocular disease.
How It's Used on the Ward
"Fundy" or "fundoscopy" — looking in the back of the eye with the scope. Most students dread it until they see their first papilledema.
Example
""New-onset severe headache in a 35-year-old: before the LP, fundoscopic exam shows blurred disc margins and loss of venous pulsations bilaterally — papilledema present. Get CT head first to rule out mass effect before proceeding with LP.""
Clinical Context
Key findings and clinical significance: papilledema (blurred/elevated disc margins, loss of venous pulsations) = elevated ICP — CT before LP. Cup-to-disc ratio >0.6 = glaucoma risk. AV nicking, copper/silver wiring, flame hemorrhages = hypertensive retinopathy. Dot/blot hemorrhages, microaneurysms, exudates, neovascularization = diabetic retinopathy (background vs proliferative). Cherry-red spot at macula = central retinal artery occlusion or storage disease. Direct ophthalmoscopy in undilated pupils is technically difficult — dilate with tropicamide for best views. Neurology, emergency medicine, and internal medicine require basic fundoscopy skills.
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