Fundoscopy interpretation

What it is

Fundoscopy is a bedside look at the back of the eye that is asked for well outside ophthalmology. In a patient with tinnitus it belongs to the complete head and neck examination and is done to look for raised ICP. In hypertension it belongs to the head and neck part of the physical examination, whose aim is to identify signs of a secondary cause, risk factors for cardiovascular disease and signs of target organ damage. In hypertension urgency, fundoscopy is one of the three tests that look for that organ damage, with a 12-lead ECG and a urine routine for proteinuria and haematuria. Hypertension urgency itself is defined as SBP 180 mmHg or above and/or DBP 110 mmHg or above without HMOD, and it is often associated with treatment discontinuation or non-adherence as well as with anxiety.

How the examination is done

Dim the lights. Use your right hand and right eye for the patient's right eye. Start about 15 cm away and approach at 15° from the temporal side.

Then focus on four things in order:

• The red reflex. If it is absent, the answer is cataract or retinoblastoma.
• The optic disc: its color, its margins, and the cup:disc ratio.
• The vessels: the AV ratio, nicking, hemorrhages.
• The macula: the foveal reflex, asking the patient to look at the light.

To complete the exam: check the intraocular pressure by tonometry; assess cranial nerves II, III, IV and VI fully; perform a slit lamp exam if available; and review any imaging, or referral to ophthalmology.