Ophthalmoscopy

Plan of action Why eyes are important in 2nd year Hypertensive and diabetic retinopathy Ophthalmoscopy Possible OSCE stations Practice

Eyes for second year Neuro – Diplopia, pupil constriction GI - Jaundice Cardio –Xanthalasma Resp – Horner’s syndrome Ophthalmoscopy Hypertensive and diabetic retinopathy

Hypertensive retinopathy I Tortuous arteries “silver/copper wiring” II Narrowing of veins due to artery compression “A-V nipping” III Blood leaking out of vessel and axons dying “Flame haemorrhages and cotton wool spots” IV ^ICP leads to optic disc swelling “Papilloedema” How to look for end-organ damage in HTN?

Diabetic retinopathy Background Pre-proliferative Proliferative Microaneurysm, dot and blot haemorrhages Pre-proliferative Cotton wool spots Proliferative Neovascularization +/- Macular oedema Hard exudates Laser photocoagulation

Ophthalmoscopy

OSCE Hello my name is X I’m a second year medical student I’ve been asked to X before I explain to you more about that can I confirm your full name and date of birth. How old does that make you? Explain procedure Is that ok with you? Wash hands (properly)

Ophthalmoscopy Ask patient to fix vision in distance. Examine external eye Dim lights Red reflex Lean in at 20 degrees Try find – Disc, vessels and macula OR read words Thank patient ?document/ present findings

Example stations Examine model and document findings Examine model and tell examiner the words you can read Cranial nerves Don’t forget history stations!

Documentation

Practice Time

Presenting findings 20yo m/f Normal lids and lashes and normal red reflex Optic disc had a normal colour, no sign of papilloedema Blood vessels appeared normal in all 4 quadrants There was no sign of macular oedema In summary this is a normal External eye

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