Ophthalmoscopic Examination. In general health care, you should usually examine your patients' eyes without dilating their pupils. Your view is therefore limited to the posterior structures of the retinal surface. To see more peripheral structures, to evaluate the macula well, or to investigate unexplained visual loss, ophthalmologists dilate the pupils with mydriatic drops unless this is contraindicated.
At first, using the ophthalmoscope may seem awkward, and it may be difficult to visualize the fundus. With patience and practice of proper technique, the fundus will come into view, and you will be able to assess important structures such as the optic disc and the retinal vessels. Remove your glasses unless you have marked nearsightedness or severe astigmatism. (However, if the patient's refractive errors make it difficult to focus on the fundi, it may be easier to keep your glasses on.)
Contraindications for mydriatic drops include (1) head injury and coma, in which continuing observations of pupillary reactions are essential, and (2) any suspicion of narrow-angle glaucoma.
Review the components of the ophthalmoscope pictured on the previous page. Then follow the steps for using the ophthalmoscope, and your examination skills will improve over time.
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