funduscopy

WordNet

1. examination of the interior of an eye using an ophthalmoscope

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/25 22:21:29」(JST)

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Ophthalmoscopy
Intervention
Ophthalmoscopic exam: the medical provider would next move in and observe with the ophthalmoscope from a distance of one to several cm.
MeSH	D009887

Ophthalmoscope (left) and otoscope combination by Welch Allyn

Fundus photographs of the right eye (left image) and left eye (right image), seen from front so that left in each image is to the person's right, demonstrating the structures that can be seen in ophthalmoscopy. Each fundus has no sign of disease or pathology. The gaze is into the camera, so in each picture the macula is in the center of the image, and the optic disk is located towards the nose. Both optic disks have some pigmentation at the perimeter of the lateral side, which is considered non-pathological.

The left image (right eye) shows lighter areas close to larger vessels, which has been regarded as a normal finding in younger people.

Ophthalmoscopy (funduscopy or fundoscopy) is a test that allows a health professional to see inside the fundus of the eye and other structures using an ophthalmoscope (or funduscope). It is done as part of an eye examination and may be done as part of a routine physical examination. It is crucial in determining the health of the retina and the vitreous humor.

An alternative or complement to ophthalmoscopy is to perform a fundus photography, where the image can be analysed later by a professional.

Types

It is of two major types:

• Direct ophthalmoscopy one that produces an upright, or unreversed, image of approximately 15 times magnification.
• Indirect ophthalmoscopy one that produces an inverted, or reversed, direct image of 2 to 5 times magnification.

Features	Direct ophthalmoscopy	Indirect ophthalmoscopy
Condensing lens	Not Required	Required
Examination distance	As close to patient's eye as possible	At an arm's length
Image	Virtual, erect	Real, inverted
Illumination	Not so bright; so not useful in hazy media	Bright; useful for hazy media
Area of field in focus	About 2 disc diameters	About 8 disc diameters
Stereopsis	Absent	Present
Accessible fundus view	Slightly beyond equator	Up to Ora serrata i.e. peripheral retina
Examination through hazy media	Not possible	Possible

Each type of ophthalmoscopy has a special type of ophthalmoscope:

• The direct ophthalmoscope is an instrument about the size of a small flashlight (torch) with several lenses that can magnify up to about 15 times. This type of ophthalmoscope is most commonly used during a routine physical examination.
• An indirect ophthalmoscope, on the other hand, constitutes a light attached to a headband, in addition to a small handheld lens. It provides a wider view of the inside of the eye. Furthermore, it allows a better view of the fundus of the eye, even if the lens is clouded by cataracts. An indirect ophthalmoscope can be either monocular or binocular. It is used for peripheral viewing of the retina.

Indications

Ophthalmoscopy is done as part of a routine physical or complete eye examination.

It is used to detect and evaluate symptoms of retinal detachment or eye diseases such as glaucoma.

In patients with headaches, the finding of swollen optic discs, or papilledema, on ophthalmoscopy is a key sign, as this indicates raised intracranial pressure (ICP) which could be due to hydrocephalus, benign intracranial hypertension (aka pseudotumor cerebri) or brain tumor, amongst other conditions. Cupped optic discs are seen in glaucoma.

In patients with diabetes mellitus, regular ophthalmoscopic eye examinations (once every 6 months to 1 year) are important to screen for diabetic retinopathy as visual loss due to diabetes can be prevented by retinal laser treatment if retinopathy is spotted early.

In arterial hypertension, hypertensive changes of the retina closely mimic those in the brain, and may predict cerebrovascular accidents (strokes).

Dilation of the pupil

To allow for better inspection through the pupil, which constricts because of light from the ophthalmoscope, it is often desirable to dilate the pupil by application of a mydriatic agent, for instance tropicamide. It is primarily considered ophthalmologist equipment. Recent developments like Scanning Laser Ophthalmoscope can make good quality images though pupils as small as 2 millimeters, so dilating pupils is no longer needed with these devices.

History

Dr. William Cumming in 1846 at the Royal London Ophthalmic Hospital (later Moorfields Eye Hospital), of his pioneering work wrote "every eye could be made luminous if the axis from a source of illumination directed towards a person's eye and the line of vision of the observer were coincident".

Although some credit the invention of the ophthalmoscope to Charles Babbage in 1847, it was not until it was independently reinvented by Hermann von Helmholtz in 1851 that its usefulness was recognized - it was to revolutionize ophthalmology.

While training in France, Andreas Anagnostakis, MD, an ophthalmologist from Greece, came up with the idea of making the instrument hand-held by adding a concave mirror. Austin Barnett created a model for Anagnostakis, which he used in his practice and subsequently when presented at the first Ophthalmological Conference in Brussels in 1857, the instrument became very popular among ophthalmologists.

In 1915, Francis A. Welch and William Noah Allyn invented the world's first hand-held direct illuminating ophthalmoscope, precursor to the device now used by clinicians around the world. This refinement and updating of von Helmholtz's invention enabled ophthalmoscopy to become one of the most ubiquitous medical screening techniques in the world today. The company Welch Allyn started as a result of this invention.

See also

• Charles Schepens
• Retinoscope
• Scanning laser ophthalmoscopy

References

External links

• Principles of Ophthalmoscopy
• Ophthalmoscopy on Medlineplus
• Ophthalmoscopy on WebMD
• Overview at bmjjournals.com
• Medlineplus about different types of ophthalmoscopy
• Phisick Pictures and information about antique ophthalmoscopes

UpToDate Contents

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• 1. 成人における詳細な神経学的検査 the detailed neurologic examination in adults
• 2. 乳頭浮腫の概要および鑑別診断 overview and differential diagnosis of papilledema
• 3. 白色瞳孔を有する小児に対するアプローチ approach to the child with leukocoria
• 4. 糖尿病性網膜症：スクリーニング diabetic retinopathy screening
• 5. 高血圧の眼への影響 ocular effects of hypertension

English Journal

• Management of spheno-orbital en plaque meningiomas: clinical outcome in a consecutive series of 40 patients.

• Boari N, Gagliardi F, Spina A, Bailo M, Franzin A, Mortini P.SourceDepartment of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy.
• British journal of neurosurgery.Br J Neurosurg.2013 Feb;27(1):84-90. doi: 10.3109/02688697.2012.709557. Epub 2012 Aug 21.
• Abstract Objective. The clinical results of combined surgical-radiosurgical treatment of the spheno-orbital en plaque meningiomas in a consecutive series of 40 patients are presented. The clinical outcome is evaluated in terms of surgical morbidity, tumour control, visual function and cosmetic res
• PMID 22905887

• Ccl2, Cx3cr1 and Ccl2/Cx3cr1 chemokine deficiencies are not sufficient to cause age-related retinal degeneration.

• Luhmann UF, Carvalho LS, Robbie SJ, Cowing JA, Duran Y, Munro PM, Bainbridge JW, Ali RR.SourceDepartment of Genetics, UCL Institute of Ophthalmology, 11-43 Bath Street, EC1V9EL London, United Kingdom. Electronic address: u.luhmann@ucl.ac.uk.
• Experimental eye research.Exp Eye Res.2013 Feb;107:80-7. doi: 10.1016/j.exer.2012.11.015. Epub 2012 Dec 8.
• Monocytes, macrophages, dendritic cells and microglia play critical roles in the local immune response to acute and chronic tissue injury and have been implicated in the pathogenesis of age-related macular degeneration. Defects in Ccl2-Ccr2 and Cx3cl1-Cx3cr1 chemokine signalling cause enhanced accum
• PMID 23232206

Japanese Journal

• 臨床研究 スマートフォンによる前眼部および眼底撮影

• 周藤 真,平岡 孝浩,岡本 芳史 [他]
• 日本眼科学会雑誌 118(1), 7-14, 2014-01
• NAID 40019948106

• 伝染性紅斑（りんご病）に合併した視神経症（炎）の成人例

• 青松 圭一,中尾 雄三,浦瀬 文明
• 神経眼科 31(3), 326-330, 2014
• 症例は近医からの紹介で51歳女性の保育士．視力低下，眼痛，羞明の症状出現の前に，手足の関節痛，頬部の発赤の伝染性紅斑を疑わせる症状があった．両側視神経乳頭浮腫を認め，眼窩部MRIではSTIR 法にて両側視神経の腫大と高輝度信号を認めた．血清学的検査では抗ヒトパルボウイルスB19IgM抗体価の上昇が確認された．治療はステロイドパルス療法を1クール施行．治療前の視力右眼（0.7），左眼（0.3），中心 …
• NAID 130005057102

• 身体活動中心臓突然死防止に向けての法医学的検討:―身体活動中突然死剖検例と安静時突然死剖検例との比較をもとに―

• 廣渡 崇郎,佐藤 啓造,入戸野 晋 [他],藤城 雅也,水野 駿,金 成彌,正村 謙二,上西 将路,安川 泰樹,加藤 晶人,李 暁鵬
• 昭和学士会雑誌 74(4), 428-453, 2014
• スポーツや身体活動が突然死の誘因となったと判断される事例が，ときどき報告される．しかし，身体活動中の心臓突然死剖検例と安静時心臓突然死剖検例を比較・検討した報告はみられない．本研究では昭和大学医学部法医学講座において行われた司法・行政解剖例のうち，身体活動中の心臓突然死15例とデスクワークないし安静時心臓突然死15例について司法解剖鑑定書もしくは行政解剖報告書の内容を詳細に検討するとともに，文献的 …
• NAID 130005056870

Related Links

• Funduscopy | definition of funduscopy by Medical dictionary

oph·thal·mos·co·py (of'thal-mos'kŏ-pē), Examination of the fundus of the eye by means of the ophthalmoscope. Synonym(s): funduscopy funduscopy. See ophthalmoscopy. funduscopy, fundoscopy (fun?dus'ko-pe) [ fundus + -scopy] ...

• Funduscopy - definition of funduscopy by The Free Dictionary

Define funduscopy. funduscopy synonyms, funduscopy pronunciation, funduscopy translation, English dictionary definition of funduscopy. n. An instrument for examining the interior structures of the eye, especially the retina ...

Related Pictures

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★リンクテーブル★

リンク元	「100Cases 14」「ophthalmoscopic」「ophthalmoscopy」「眼底検査」「funduscopic」

「100Cases 14」

　　[★]

☆case14　複視

■glossary

diplopia n. 複視

筋力低下、筋無力、筋脱力 muscle weakness, muscular weakness

sunken

vt. sinkのpp.

adj.

沈没した、沈んだ、水中の

沈下した、一段低いところにある

落ち込んだ、くぼんだ

3,4-ジアミノピリジン 3,4-diaminopyridine 3,4-DAP K+チャネル阻害薬;ランバート・イートン筋無力症治療

■症例

43-year-old woman

cheif complaint: diplopia

present history: diplopia and holding her head up ; more marked in the evenings, for the last 3 months. difficulty of chewing. voice has become quieter. weight loss (3kg / 6months). non-smoker. drinks about 15 units/week. no regular medication.

past history: no significant previous medical illnesses.

family history: lives with her husband and three children.

・診察 examination

looks well.

organ systems: normal; cardiovascular, respiratory, and abdominal systems.

muscle power; grossly normal. decrease after testing a movement repetitively.

motor function: normal; tone, coordination, reflexes and sensation.

bilateral ptosis. exacerbated by prolonged upward gaze

eye: normal; pupillary reflexes, eye movements, and funduscopy

■答え

diagnosis: myathenia gravis

differential diagnoses:

CASES

上位and/or下位運動ニューロン motor neurone disease　運動ニューロン疾患：線維束性攣縮。進行例では筋力低下

筋 muscular dystrophy　筋ジストロフィー：ある種の筋肉が選択的に筋力低下する。家族歴がある。

筋 dystrophia myotonica　強直性筋ジストロフィー：咬筋、側頭筋、胸鎖乳突筋の筋萎縮、四肢遠位端の筋萎縮。顔貌が特徴的(前頭部脱毛、無表情、窪んだ頬)。家族歴ある。筋電図が診断に有用(急降下爆撃音)。

筋 polymyositis　多発筋炎：普通は皮疹と関節痛が出現。CKが上昇。筋生検が診断に有用

筋 myopathy　ミオパチー：甲状腺中毒性ミオパチー、甲状腺機能低下症によるミオパチー、クッシング症候群によるミオパチー、アルコール性のミオパチー

神経筋接合部？ non-metastatic associations of malignancy (paraneoplastic syndrome(傍腫瘍性症候群 = 腫瘍随伴症候群)のこと)：胸腺腫の症例の10%に重症筋無力症がみられる。ランバート・イートン筋無力症症候群は小細胞癌と関連がある。

HIM.2674

• 神経筋接合部 congenital myasthenia syndrome　先天性筋無力症症候群
• 神経筋接合部 drug-induced myasthenia　薬剤性筋無力症

Treatment with penicillamine (used for scleroderma or rheumatoid arthritis) may result in true autoimmune MG, but the weakness is usually mild, and recovery occurs within weeks or months after discontinuing its use.

　重症筋無力症の誘発：ペニシラミン(強皮症や関節リウマチの治療に用いられる)。

　　mildだし、薬剤の中断で改善する。

Aminoglycoside antibiotics or procainamide can cause exacerbation of weakness in myasthenic patients; very large doses can cause neuromuscular weakness in normal individuals.

　重症筋無力症の悪化：アミドグリコシド系抗菌薬、プロカインアミド

　　MGの患者の筋脱力が悪化する。

• 神経筋接合部 Lambert-Eaton myasthenic syndrome　ランバート・イートン筋無力症症候群：全身の筋肉が冒されるが、特に下肢の近位筋が冒される。MGと同じように～70%の患者で脳神経所見(眼瞼下垂、複視など)が認められる。MGと違うのは(1)反射が消失・減弱すること、(2)自律神経系の変化(口渇、勃起不全)を生じる、(3)神経刺激検査で漸増(waxing)が見られることである。病因は神経筋接合部のP/Q type calcium channelsに対する抗体の出現であり、85%の患者で見いだされる。治療はMGのように血漿交換や免疫抑制薬が使われる。3,4-DAPやpyridostigmineは症状に対する治療のために用いる。前者は運動神経の終末部でカルシウムチャネルをブロックし活動電位を延長させる。後者はアセチルコリンエステラーゼを阻害してシナプスにおける神経伝達物質の濃度を上げる。
• 精神疾患 neurasthenia　神経衰弱症：歴史的な用語。器質的な障害を伴わない筋無力症のような脱力を伴う症候群。患者は筋脱力や疲労を訴えてやってくる。筋肉の検査では器質的変化は認めないが"jerky release"あるいは"give-away weakness"が認められる。患者の主訴は反復動作による筋力低下よりむしろ疲労や感情鈍麻である。
• 内分泌疾患 hyperthyroidism　甲状腺機能亢進症：MGが疑われる患者にはthyroid function testをルーチンにやる。甲状腺機能異常は筋無力症の筋力低下を大きくすることがある。
• 神経筋接合部 botulism　ボツリヌス症：ボツリヌス毒素はシナプス前膜からの神経伝達物質の開口分泌を妨げる。症状はbulbar weakness (複視、構音障害、嚥下困難)。感覚障害はない。深部腱反射は初期には保たれている。進行すれば反射は見られなくなる。筋脱力は全身性。呼吸困難に陥ることがある。精神状態は正常。自律神経症状(麻痺性イレウス、便秘、urinary retention、瞳孔の散大、瞳孔の反応性低下、口渇)。確定診断は血清中の毒素の検出だけど、見つかることはまれ。神経伝導検査(nerve conduction studies)：compound muscle action potentials (CMAPs)の低下。高頻度の刺激で振幅が増加。治療：intubation for airway protection、呼吸補助、aggressive inpatient supportive care(e.g., nutrition, DVT prophylaxis)。馬の抗毒素を検査結果が帰ってくる前に投与する(？)。
• 上位運動ニューロン intracranial mass lesions　頭蓋内占拠病変：複視はintracranial mass lesionが外眼筋の神経を圧迫することにより生じる。
• 筋 progressive external ophthalmoplegia　進行性外眼筋麻痺：外眼筋の筋脱力を伴う。四肢の近位筋の筋力低下やそのほかの全身症状を伴うことがある。ミトコンドリアの異常を有する。

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「ophthalmoscopic」

　　[★]

• 眼底検査の、検眼鏡検査の

関

fundoscopy、funduscopic、funduscopy、ophthalmoscopy

「ophthalmoscopy」

　　[★]

• 眼底検査、検眼鏡検査

関

fundoscopy、funduscopic、funduscopy、ophthalmoscopic

　

「眼底検査」

　　[★]

英

funduscopy, fundus examination

ラ

funduscopia

関

検眼鏡、細隙灯顕微鏡

「funduscopic」

　　[★]

• 眼底検査の

関

fundoscopy、funduscopy、ophthalmoscopic、ophthalmoscopy