Synopsis
Obtain and describe the red reflex and a systematic direct fundus view, recognise important abnormalities and explain when a limited examination needs specialist completion.
- Measure vision and record pupils before dilation, and ask about trauma, pain, flashes, floaters, headache and recent surgery.
- Dim the room, explain the close working distance and start by comparing the reflex from each pupil at a distance.
- Use the right eye and hand for the patient's right eye and the left side for the left, approaching through the reflex while maintaining alignment.
Key red flags
A white pupil or asymmetric, absent or partly obscured reflex in a baby needs prompt specialist referral; discuss significant concerns with ophthalmology before discharge rather than simply booking another routine screen.
Investigation priorities
Assess optical clarity and identify asymmetry before attempting detailed fundoscopy.
Management branches
The patient is stable and direct ophthalmoscopy is clinically appropriate.
- Record acuity, relevant symptoms and undilated pupil findings, explain the examination and establish comfortable distant fixation.
- Compare the reflexes, follow one into the eye and inspect the disc, vessels and visible retinal areas systematically.
Key medicines
Minims tropicamide 0.5% eye dropsFor an adult diagnostic episode, instil one drop into the eye being examined, then a second drop after five minutes; a further drop after thirty minutes may be used if required by the examination. Discard the single-use unit afterwards.