Fundoscopy

Procedure

Scope

The purpose of this page is to help you appear confident using fundoscopy in your exams (medical school finals, PACES) and for MCQ in medical school finals and MRCP Part 1 & 2. Clearly you need to know the basics of how to turn on the machine, hold it and look throught the correct end! However, clinically I feel only senior doctors or neurologists are confident enough with fundoscopy to use it to change management. This page is directed at eye signs in medical conditions rather than ophthamology disorders. 

Performance

• Appear confident

• Patient positioning: focus on the wall directly ahead, sitting down

• Introductory speech: 

  • I'm going to have a look at the back of you eye

  • For this I'm going to shine a light into the back of your eye and sit close to you

  • This can feel a little uncomfortable, if at any time you feel it is uncomfortable please let me know and we can stop

  • Please focus on the wall in front of you and look through me as I come closer

  • Please blink normally and breath normally 

Procedure

• Looking through the ophthalmoscope shine the light into the patient's eye

• Note the red dot and move closer, trying to fully visualise the optic disc

Indications

Medical School Finals & PACES

• Concern of condition below

• Offer as part of Cranial Nerve Examination

AZ

Signs

• Cotton Wool Spots: Diabetes, 

• Optic atrophy: Friedreich's Ataxia

• Optic disc swelling

  • Papilloedema (bilateral): raised intracranial pressure- space occupying lesion (Brain Cancer, Brain Abscess), Brain Infection; IIH, Hypertension

  • Papillitis (usually unilateral): optic neuritis- MS

• Roth spots: Infective Endocarditis, Hypertension, Diabetes

Conditions

Systemic

• Diabetes: diabetic retinopathy- cotton wool spots, microaneurysms, hard exudates,

• Friedreich's Ataxia: Optic atrophy

• Hypertension: hypertensive retinopathy- arterial narrowing, AV nicking, Papilloedema

• IIH: Papilloedema

• Infective Endocarditis: Roth spots

• MS- unilateral Papillitis: optic neuritis

Eye

• Glaucoma- increased cup to disc ratio

Eye Examination Findings

Systemic Diseases

• Graves Disease- proptosis (exophthalmos), lid lag, lid retraction, ophthalmoplegia 

• Wilson's Disease- Kayser–Fleischer rings: seen from end of bed and slit lamp, fundoscopy normal

• Marfan's Syndrome - upward lens dislocation

• Homocystinuria - downward lens dislocation

• Neurofibromatosis type 1- Lisch Nodules (irish hamartomas),

• Tuberous Sclerosis- retinal astrocytic hamartomas

• Acute anterior uveitis

  • HLA-B27 (PEAR): Psoriatic Arthritis, Enteropathic (IBD), Ankylosing Spondylitis, Reactive Arthritis;  

  • Sarcoidosis, Behcet's Disease  

• Giant Cell Arteritis - acute anterior ischaemic optic neuropathy

• Multiple Sclerosis (MS) - optic neuritis

• Myasthenia Gravis (MG) - ptosis, diplopia, fatiguability

• Lung Cancer- Horner's Syndrome- PAM: ptosis, anhyidrosis, miosis

Written in 2026.