Introduction
Fundoscopy is one of the most common procedures performed by an ophthalmologist. It is a test to analyze the innermost structures of the eyeball.
Definition
Fundoscopy is a procedure used for the visualization of the retina and fundus in order to identify pathological changes in the fundus, optic nerve, and retina of the eye.
Purposes
- To inspect the abnormalities of the fundus, optic nerve, and retina for early detection and prompt management.
- To screen, assess, and analyze a disease or specific area of damage.
Types
- Direct examination
- Indirect examination
- Slit lamp examination
Indications
- As a part of routine screening in adults.
- Patients with comorbid illnesses such as hypertension, diabetes, and cardiac disease.
- Patients with visual disturbances such as blurry vision, loss of vision, and ocular pain.
- Patients with eye-related disorders such as optic nerve damage, retinal tear/retinal detachment, glaucoma, macular degeneration, cytomegalovirus retinitis, and eye cancer.
Contraindication
- Allergy to mydriatics.
Articles
| Articles | Purpose |
| Ophthalmoscope | To visualize the retina. |
| Mydriatic eye drops (e.g., tropicamide 1%) | To dilate the pupils. |
| Medication card | To prevent error. |
| Eye care tray | To prevent infection. |
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | Allays anxiety and obtains cooperation from the patient. |
| 2. | Obtain informed consent from the patient. | Serves as legal evidence. Prevents litigation of the staff. |
| 3. | Position the patient with the head extended. | To visualize the eye. |
| 4. | Inspection Observe for eyelids, pupil, and periorbital region, and note any abnormalities such as swelling, redness, and discharge. | To find abnormalities. |
| 5. | Assess for pupil size, shape, symmetry, and color. | To detect abnormalities. |
| 6. | Psychologically prepare the patient for fundoscopy. | To alleviate fear. |
| 7. | Provide eye care and instill eye drops. | General preparation before the procedure. |
| 8. | Instruct the patient to rotate the eyeball and keep eye closed. | Helps to spread the medication throughout the eye. |
| 9. | Position the patient properly and turn off the lights. | To promote clear visualization. |
| 10. | A beam of light is reflected into the patient’s eye. | To illuminate retina. |
| 11. | Observe for a reddish/ orange/ white/ yellow/blue reflection in each pupil, caused by light reflecting back from the vascularized retina. | To detect abnormalities. |
| 12. | Document the procedure: Record the date, time, and patient’s response to the procedure. | Serves as legal evidence and prevents duplication of care. |
Special Considerations
- Gain consent and assess for discomfort or anxiety.
- Dilating drops may be used to widen pupils for better visualization inform patients about temporary blurred vision and light sensitivity afterward.
- Ensure the patient is seated comfortably, with their head supported. Ask them to fix their gaze on a distant object.
- Perform the exam in a dimly lit room to promote natural pupil dilation.
- Minimize distractions and glare to enhance visualization of the fundus.
- Use the correct aperture on the ophthalmoscope:
- Small beam for constricted pupils.
- Large beam for dilated pupils.
- Red-free filter to enhance contrast of blood vessels and hemorrhages.
- Be mindful of comorbidities like cataracts or macular degeneration that may obscure the view.
- Use gentle reassurance and adapt communication strategies.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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