RetinaExamination&investigation

Dr_Mohamed ELShafie, assistant lecturer

Anatomy

• It is the senstive and inner most layer of the eye

• Derived from neural ectoderm• Extend from optic disc centrally to ora serrata

peripherally……..

Minute anatomy

Histologically formed of ten

layers

1 .The pigment epithelium2. The rods and cones3. The external limiting membrane

4 .The outer nuclear layer5. The outer plexiform layer6. The inner nuclear layer

7 .The inner plexiform layer8. The ganglion cells

9. The nerve fiber layer10.The internal limiting membrane

Blood Supply of the Retina

(1) The outer laminae, including the rods and cones and outer nuclear layer, are supplied by the choroidal capillaries

(2) The inner laminae are supplied by the central artery and vein.

central retinal vein ….drain into cavernous sinus

Fundus examunation

Direct ophthalmoscope• Uniocular• No stereopsis• Erect image• high magnification ×15• small field

Indirect ophthalmoscope• Binocular vision• Stereopsis• Inverted image• Low magnification ×5• Large field

Slit lamp biomicroscopically

With contact lensGoldman 3 mirror lens

With non contact lens• Biconcave(Hruby lens)

• Biconvex lens (+60&+78&+90)

Appearane of normal fundus

How to test the center of the retina = macula = macular function tests• Form sense: VA

• Colour sense:

Clear media: ishihara colour book

Opaque media:Ophthalmoscope coloured filters + light source

Some investigations

OCT

Flourescein angiography

Visual field examination

Conferentation test

• Compares peripheral vision with a tester who has normal peripheral vision

• 2 ft. apart, eye level

• Tester & client cover opposite eyes

• Tester advances finger in the periphery– Superiorly ( 50 degrees )– Inferiorly ( 70 degrees )– Temporally ( 90 degrees )– Nasally ( 60 degrees )

3_Perimetery

Visual field defect

• scotoma blind spot is physiological -ve scotoma

• Hemianopia involve one half of field(heterogenous& homonymous)

Fundus picture of some diseases• Diabetic Retinopathy

•VEDIO

PRP

Hypertensive Retinopathy

CRAO&CRVO

BRAO&BRVO

Embolization is the most common cause of obstruction to the retinal circulation, e.g. an embolus from a vegetation on one of the valves of

the heart in cases of subacute bacterial endocarditis

Degenerative changes within the arterial wall, e.g. arteriosclerosis or atherosclerosis.

Rhegmatogenous RD

Tractional RD

Retinitis pigmentosa

34

Retinoblastoma.

35

RETINOPATHY OF PREMATURITY

papilloedema

1ry optic atrophy

Glaucomatous optic atrophy