funduscopy

Funduscopy, or ophthalmoscopy, is the examination of the fundus—the interior surface of the eye, including the retina, optic disc, macula, and posterior pole. It is used to assess ocular and systemic disease and to document retinal appearance. The exam can be done directly with a handheld direct ophthalmoscope or indirectly with a binocular ophthalmoscope, often using a condensing lens; slit-lamp biomicroscopy with a three-mirror lens is another approach.

Direct ophthalmoscopy gives a magnified, upright view of a small field. Indirect ophthalmoscopy provides a wider panoramic view, often inverted, enabling examination of the peripheral retina and vitreoretinal interface. Pupil dilation with mydriatic drops is commonly used to improve visualization, and the observer may examine in upright or prone positions.

Indications include routine screening and evaluation of conditions such as diabetic or hypertensive retinopathy, glaucoma, retinal detachment, retinal vascular occlusions, macular disease, optic neuropathies, trauma, and inflammatory disorders.

Normal fundus examination shows a healthy optic disc with sharp margins and a physiologic cup, a normal retina with fine vascular pattern, a macula without edema, and no retinal tears or hemorrhages. Abnormal findings may include pallor or swelling of the optic disc, cupping, cotton-wool spots, hemorrhages, microaneurysms, exudates, retinal tears or detachments, neovascularization, or vitreous debris.

Limitations include dependence on examiner expertise, patient cooperation, and media clarity. Some individuals may not tolerate dilation or examination; the indirect method requires specialized equipment and training. Findings may be subtle and require corroboration with imaging.

Funduscopy is a foundational skill in ophthalmology and primary care, essential for detection and monitoring of ocular and systemic diseases. Adequate training and regular practice improve diagnostic accuracy and exam speed.