PEMERIKSAAN MATA

SYMPTOMS AND SIGNS

MOST OF THE PRESENTING MANIFESTATION OF THE EYE INVOLVEMENT FALL INTO ONE OF THE FIVE CATAGORIES 1. SUBNORMAL VISUAL ACUITY 2. PAIN OR DISCOMFORT 3. CHANGE OF APPEARANCE OF LIDS, ORBIT OR THE EYE 4. DIPLOPIA 5. DISCHARGE OR INCREASE CONJUNGTIVAL SECRETION

SUBNORMAL VISUAL ACUITY

A. DURATION
- IS THE PATIENTS VISUAL ACUITY SAME AS IT HAS BEEN FOR THE MOST OF HIS LIFE ? - WAS THE CHANGE IN ACUITY RECENTLY NOTES ? - WAS IT FOUND BY ACCIDENTALLY COVERING ONE EYE ? - HAS THER BEEN A GRADUAL DIMINUTION OF ACUITY OVER MANY MONTHS OR YEARS ?

B. DIFFERENCE IN VISUAL ACUITY IN THE TWO EYES

- IS THE PATIENT CERTAIN THAT VISUAL ACUITY WAS FORMELY THE SAME IN BOTH EYES ?

C. DISTURBANCES OF VISION
1. METAMORPHOSIA DISTORTION OF THE NORMAL SHAPES OF OBJECT. DUE TO : - ASTIGMATISM - MACULAR LESION

2. PHOTOPHOBIA INCREASE LIGHT SENSITIVITY, DUE TO : - CORNEAL INFLAMATION - APHAKIA - IRITIS - OCULAR ALBINISM - DRUGS, SUCH AS CHLOROQUINE, ACETAZOLAMIDE

3. CHROMATOPSIA COLOR CHANGE SUCH AS YELLOW WHITE OR RED VISION, DUE TO : - CHORIORETINAL LESION - LENTICULAR CHANGE - JAUNDICE 4. HALOS OR RINGS SEEN WHEN VIEWING LIGHTS OR BRIGHT OBJECTS, DUE TO : - GLAUCOMA / CORNEAL OEDEMA - INCIPIENT CATARACT

5. SPOTS BEFORE THE EYES, SEEN AS DOTS OR FILAMENTS, WHICH MOVE WITH MOVEMENT OF THE EYE, DUE TO BENIGN VITREUS OPACITIES

6. VISUAL FIELD DEFECTS DUE TO DISORDERS OF : - CORNEA - MEDIA - OPTIC NERVE - BRAIN

7. NYCTALOPIA / NIGHT BLINDNESS DIFFICULTY SEEING IN THE DARK - CONGENITAL, RETINITIS PIGMENTOSA - ACQUIRED, VITAMIN A DEFICIENCY, GLAUCOMA, OPTIC ATROPHY, CATARACT, RETINAL DEGENERATION 8. AMAUROSIS FUGAX MOMENTARY LOSS OF VISION, DUE TO : - IMPENDING CEREBROVASCULAR ACCIDENT - SPASM OF THE CENTRAL RETINAL ARTERY - PARTIAL OCCLUSION OF THE INTERAL CAROTID ARTERY

PAIN OR DISCOMFORT
THE USUAL PAINFUL SYMPTOMS, MENTIONED ARE : - HEADCHE - EYE-ACHE
ACUTE LOCALIZED PAIN INTENSIFIED BY MOVEMENT OF THE EYE OR LID SUGGEST : - FOREIGN BODIES - CORNEAL ABRASION

 HEADCHE THAT OCCURS UPON ARISING IN THE MORNING AND DISSAPEARS SOON AFTERWARD IS SELDOM CAUSED BY EYE DISORDERS, A GENERAL MEDICAL EXAMINATION IS INDICATED MILD TO MODERATE HEADCHE WHICH OCCUR TOWARD THE END OF A DAY OF EXACTING EYE WORK AND WHICH ARE RELIEVED BY A FEW HOURS OF REST OR SLEEP ARE MORE PROBABLY DUE TO OCULAR DISORDERS

 SEVERE HEADCHE WHICH IS BECOMING WORSE SHOULD SUGGEST AN INTRACRANIAL LESION : - VISUAL FIELD TEST - OPHTHALMOSCOPY - NEUROLOGIC INDICATED CONSULTATION

 EYE-ACHE - MUSCLE IMBALANCE - INFLAMATORY LESIONS INVOLVING THE EPISCLERA, IRIS, CHOROID - INCREASED PRESSURE OF GLAUCOMA - FEVER, NEURALGIA, RETROBULBAIR NEURITIS, TEMPORAL NEURITIS - SEVERE INFLUENZA AND DENGUE

 BURNING AND ITCHING INFLAMATION OF THE LIDS OR CONJUNGTIVA, SUCH AS : - CHRONIC BLEPHARITIS - CONJUNGTIVITIS - ALLERGIC REACTIONS ITCHING IS A SYMPTOM OF OCULAR ALLERGY

CHANGE IN APPEARENCE
A. DISCOLORATION
REDNESS OR CONGESTION OF THE LIDS, CONJUNGTIVA OR SCLERA, MAYBE DUE TO AN ACUTE INFLAMATORY REACTION TO : - INFECTION - TRAUMA - ALLERGY - ACUTE GLAUCOMA SUBCONJUNGTIVAL HAEMORRHAGE IS A SUDDEN IN ONSET AND BRIGHT RED IN APPEARANCE

B. SWELLING

- SWELLING OF ONE LID SUGGEST A LOCAL ABSCESS - BILATERAL SWELLING INDICATES A MORE GENERALIZED REACTION SUCH AS BLEPHARITIS, ALLERGY, MYXEDEMA

C. MASS

AN ORBITAL MASS MAY OCCUR, CAUSING DISPLACEMENT OF THE GLOBE

DIPLOPIA
DOUBLE VISION OCCURS IN PARALYSIS OF THE EXTRA OCULAR MUSCLES

MONOOCULAR DIPLOPIA OCCURS IN : - LENTICULAR CHANGES - MACULAR LESION - MALINGERING - HYSTERIA

DISCHARGE
IF THE DISCHARGE IS WATERY (EPIPHORA) AND NOT ASSOCIATED WITH REDNESS OR PAIN, CAUSED BY EXCESSIVE FORMATION OF TEARS OR OBSTRUCTION OF THE LACRIMAL DRAINAGE SYSTEM IF THE DISCHARGE IS WATERY BUT ACCOMPANIED BY PHOTOPHOBIA OR BURNING, VIRAL CONJUNGITIVITIS OR KERATOCONJUNGTIVITIS MAYBE PRESENT A PURULENT DISCHARGE USUALLY INDICATES A BACTERIAL INFECTION

PHYSICAL EXAMINATION
VISUAL ACUITY
DISTANT VISION. IN TESTING FOR DISTANCE A RANGE OF 20 FEET (6 METER) IS SELECTED, SINCE RAYS OF LIGT FROM THIS DISTANCE ARE PRACTICALLY PARALEL

SNELLEN CHART CONSIST OF SQUARESHAPED LETTERS ARANGED UPON A CHART, THE SIZE OF THE LETTERS DIMINISHING FROM ABOVE DOWN WARD. THE HIGHT OF EACH LETTER SUBTEND A VISUAL ANGLE OF 5 AND THE WIDTH OF THE COMPONENT LIMBS A VISUAL ANGLE OF 1

THE UPPERMOST LETER IS OF SUCH A SIZE THAT IT CAN BE READ AT 200 FEET ; THEN FOLLOW ROWS OF LETTERS WHICH SHOULD BE READ. AT 100, 70, 50. 40, 30, 20, 15 AND 10 FEET.

- THE VISUAL ACUITY,, IS

EXPRESSED BY FRACTION: THE NUMERATOR OF WHICH CORRESPONS TO T14E NUMBER OF FEET SEPARATING THE PATIENT FROM THE CHART ( PREFERABLY 20 FEET ), AND THE DENOMINATOR, TO THE NUMBER INDICATING THE DISTANCE AT WHICH THE SMALLEST LETTERS SEEN SHOULD BE READ BY THE NORMAL EYE.

- IF THE PATIENT HAS AVERAGE NORMAL SIGHT,, THIS IS EXPRESSED V.A = 20/20 (OR 6/6).

IF HE CAN SEE ONLY THE THIRD LINE FROM THE TOP, VA = 20/70. IF HE CANNOT READ MORE THAN THE TOP LETTER, VA = 20/200

IF THE PATIENT'S VISUAL ACUITY IS LESS THAN 20/200, COUNT THE EXAMINER'S EXTENDED FINGERS.
IF HE CAN COUNT FINGERS AT I METER VA = 1/60.

- IF HE HAS LESS SIGHT THAN THIS THE HAND IS MOVED BEFORE THE EYE AND HE IS CAPABLE OF APPRECIATING SUCH MOVEMENT, VA = PERCEPTION OF HAND MOVEMENTS OR 1300. - IF VISION IS STILL FURTHER REDUCED, PERCEPTION OF LIGHT IS TESTED AND VA : LIGHT PERCEPTION.

- EACH EYE IS TESTED SEPARATELY,, ONE EYE IS BEING COVERED.

- WHEN THE PERSON IS ILLITERATE, OR IN THE CASE OF CHILDREN,, A SERIES OF LETTER E. WITH SIZES CORRESPONDING TO THOSE OF SNELLEN CHART, IN WHICH THE OPENING POINT DOWN WARD,, UPWARD AND TO THE RIGHT AND LEFT.

B. NEAR VISION
- JAEGER CHART : CONSIST OF
DIFFERENT SIZES OF ORDINARY PRFNTERS'S TYPES; THE FINNEST IS NUMBERED I,, SUCCESIVE NUMBERS INDICATING COARSER TYPES. - ACUITY OF NEAR VISION IS EXPRESSED BY J, FOLLOWED BY THE NUMBER CORRESPONDING TO THE FINEST PRINT WHICH CAN BE READ. - J 3 MEANS THAT THE PATIENT IS ABLE TO READ THE THIRD PARAGRAPH.

EXTERNAL EXAMINATION
GENERAL INSPECTION WILL REVEAL ANY OBVIOUS ABNORMALITIES, SUCH AS:
ASYMMETRY OF THE FACE OR ORBITS. ANOMALIES OF MOVEMENT OF THE LIDS SWELLING CONGESTION DISCHARGE LACRIMATION BLEPHAROSPASM

THE LIDS ARE OBSERVED

- FOR THICKNESS, COLOR AND POSITION - THE CONDITION OF THEIR MARGIN WHETHER REDENNED,SWOLLEN,CRUSTED OR ULCERATED. - THE POWER OF OPENING & CLOSING - THE SIZE OF THE PALPEBRAL APERTURE

- THE CONDITION, POSITION & DIRECTION OF EYE LASHES. - THE POSITION OF THE LACRIMAL PUNCTA

THE REGION OF THE TEAR SAC IS EXAMINED FOR SWELLING AND WHETHER PRESSURE WITH THE TIP OF INDEX FINGER CAUSES ESCAPE OF SECRETION UGH THE PUNCTA.

CONJUNCTIVA
- IN ORDER TO EXAMINE THE WHOLE CONJUNCTIVAL SAC, IT IS NECESSARY TO EXPOSE THE PALPEBRAL CONJUNCTIVA AND THE FORNICES. THE LOWER FORNIX IS EASILY EXPOSED BY DRAWING DOWN THE LOWER LID, WHILE THE PATIENT LOOKS TOWARD THE CEILING.

THE UPPER PALPEBRAL CONJUNCTIVA IS EXPOSED BY EVERTING THE UPPER LID. EVERSION OF THE UPPER LID REQUIRE SOME PRACTICE. GRASP THE SKIN OF THE UPPER LID WITH LEFT INDEX FINGER AND THUMB WHILE PATIENT IS LOOKING TOWARD HIS FEET, AND ROTATE IT.

CONGESTION OF THE CONJUNCTIVAL VESSELS, LEAVING RELATIVELY WHITE ZONE AROUND THE CORNEA AND ACCOMPANIED BY MUCOUS OR MUCOPURULENT SECRETION, IS INDICATIVE OF CONJUNGTIVITIS.

IF THERE IS MUCH IRRITATION AND PHOTOPHOBIA WITH SOME BLEPHAROSPASM WE SUSPECT THE PRESENCE OF - FOREIGN BODY - MISPLACED LASHES - IRRITATION OF THE CORNEA

CILIARY CONGESTION INDICATES INVOLVEMENT OF THE INNER EYE, PARTICULARLY INFLAMATION OF THE IRIS AND SCLERA.

CONJUNGTIVAL CONGESTION OF ONE EYE ONLY OR SIGN OF IRRITATION SUCH AS WATERING, SHOULD LEAD AS TO SUSPECT THE EFFICIENCY OF THE LACRIMAL DUCT.
SIMPLE EPHIPORA OR FLOW OF TEARS ON THE CHEEK MAY BE DUE MALPOSITION OF THE LOWER PUNCTUM; OR TO BLOCKAGE OF THE CANALICULI OR NASAL DUCT. THE PRESENCE OF DISTENSION AND INFLAMATION OF THE LACRIMAL SAC SHOULD BE NOTED. THE STRUCTURE IS SITUATED IN THE LACRIMAL FOSA BETWEEN THE INNER CANTHUS AND THE NOSE.

THE SCLERA
INSPECTION OF THE SCLERA AROUND THE CORNEA MAY REVEAL THE RAISED CONGESTED NODULES OF EPISCLERITIS, WHILE DEEP SCLERLTIS MAY BE SHOWN BY CILIARY CONGESTION AND OPACIFICATION OF DEEPER LAYERS OF THE CORNEA AT THE PERIPHERY.

THE CORNEA THE CORNEAL SURFACE SHOULD BE BRIGHT, LUSTROUS AND TRANSPARANT. ANY LOSS OF SUBSTANCE, SUCH AS ABRASION, MAY EASILY OVERLOOKE WITHOUT SPECIAL METHOD OF EXAMFNATION

PLACIDO'S KERATOSCOPIC DISC, ON WHICH ARE PAINTED ALTERNATING BLACK AND WHITE CIRCLES. THE OBSERVER LOOKS THROUGH A HOLE IN THE CENTRE AT THE CORNEAL IMAGE AS REFLECTED FROM A LIGHT BEHIND THE PATIENT, IRREGULARITIES IN THE RINGS BETRAY IRREGULARITIES ON THE CORNEAL SURFACE.

FLUORESCEIN TEST IS THE MOST USEFULL CORNEAL STAINING TO DELICATE AREAS DENUDED OF EPITHELIUM - ABRASIONS - MULTIPLE EROSIONS - ULCERS

OPACITIES OF THE CORNEA MAY BE SO FAINT THAT THEY REQUIRE MINUTE INVESTIGATION AND THE SAME IS TRUE OF THE DETAILS AND DEPTH OF GROSS OPACITIES. THESE CAN BEST BE STUDIED WITH THE SLIT LAMP.
OF PARTICULAR IMPORTANCE IS THE DETECTION OF THE MINUTE EPITHELIAL OR SUBEPITHELIAL LESIONS OF A PUNCTATE KERATITIS AS WELL AS OF KERATIC PRECIPITATES (KP).

IN MANY DESEASES NEW VESSELS (NEOVASCULARIZATION) ARE FORMED IN THE CORNEA.

THE SENSIBILITY OF THE CORNEA MAY BE TESTED BY TOUCHING IT IN VARIOUS SPOTS WITA A WISP OF COTTON-WOOL TWISTED TO A FIND POINT AND COMPARING THE EFFECT WITH THAT ON THE OPOSITE SIDE. NORMALLY THERE IS A BRISK REFLEX CLOSSURE OF THE LID.

THE ANTERIOR CHAMBER.

THE ANTERIOR CHAMBER IS SHALLOW IN EXTREME YOUTH AND IN OLD AGE; AT THE OTHER PERIOD OF LIFE IT IS NORMALLY ABOUT 2,15 MM DEEP, THE DEPTH OF THE ANTERIOR CHAMBER IS ESTIMATED BY THE POSITION OF THE IRIS. THE ANTERIOR CHAMBER IS SHALLOW IN CLOSED -ANGLE GLAUCOMA; ABNORMALLY DEEP IN IRIDOCYCLITIS.

IT IS FREQUENTLY UNEQUAL IN DEPTH IN DIFFERENT PARTS FOR EXAMPLE: - IT MAY BE DEEPER AT THE PERIPHERY THAN IN THE CENTRE IN IRIDOCYCLITIS; - ON THE OTHER HAND, WHEN THE IRIS IS BOWED FORWARDS (IRIS BOMBE) IT IS FUNNEL SHAPED, THE CENTRE BEING DEEP, THE PERIPHERY SHALLOW. - SUBLUXATION OF THE LENS CAUSES IT TO BE DEEPER ON ONE SIDE THAN ON THE OTHER.

AFTER CONSIDERING THE DEPTH,, ATTENTION MUST BE PAID TO THE CONTENTS.

IN INFLAMTORY CONDITIONS OF THE UVEAL TRACT WHEN THE PERMEABILITY OF THE VESSELS IS INCREASED, THE AQUEOUS MAY CONTAIN PARTICLES OF PROTEIN OR FLOATING CELLS.

IN SLIGHTER DEGREES THEIR PRESENCE PRODUCT AN AQUEOUS FLARE WHICH MAY BE VISIBLE ONLY WITH THE SLIT LAMP WHEN ITS BEAM IS FOCUSED TO A POINT; IN ITS MORE EXTREME DEGREES. A TURBIDITY EXISTS EASILY DISTINGUISHABLE BY THE LOUPE. - IN THE POSTERIOR SURFACE OF THE CORNEA PROTEIN MATERIAL OR CELLS ARE DEPOSITED (KP: KERATIC PRECIPITATES).

- OCCASIONALLY THERE IS PUS IN THE ANTERIOR CHAMBER FORMING A SEDIMEN AT THE BOTTOM,, THE SURFACE OF WHICH IS LEVEL (HYPOPION).

- A SIMILAR COLLECTION OF BLOOD MAY OCCUR AFTER CONTUSIONS OR SPONTANEOUSLY (HYPHAEMA).

THE IRIS
THE COLOUR OF THE IRIS AND THE CLARITY OF ITS PATTERN SHOULD FIRST BE NOTED.

SOME PARTS OF THE IRIS MAY BE OF DIFFERENT COLOUR CONDITIONS WHICH IS KNOWN AS HETEROCHROMIA IRIDIS.

A GREY IRIS WITH AN ILL-DEFINED PATTERN SUGGESTS ATROFY FROM CYCLITIS AND PATCHES OF ATROFY SUGGEST GLAUCOMA

MUDDINES OF THE IRIS " IS THE EXPRESSION USED FOR INDISTINCTNESS OF THE PATTERN, CAUSED BY INFLAMATORY EXUDATES; A MUDDY IRIS, WITH IRREGULAR PUPIL AND SLUGGIST REACTION TO LIGHT, IS INDICATIVE OF IRITIS OR IRIDOCYCLITIS.

THE POSITION OF THE IRIS MUST BE NOTED, ESPECIALLY THE PLANE WHICH IT LIES. SPESIAL ATTENTION SHOULD PE PAID TO ANY ADHESIONS( SYNECHIAE ), ANTERIOR (TO THE CORNEA) OR POSTERIOR (TO THE LENS CAPSULE).

TREMULOUSNESS OF THE IRIS (IRIDODONESIS) SEEN WHEN THE EYES ARE MOVED RAPIDLY IF THIS TISSUE IS NOT PROPERLY SUPPORTED BY THE LENS: -IN ABSENCE OF THE LENS (APHAKIA) -SUB LUXATION OF THE LENS.

THE PUPILS
THE CONDITION OF THE PUPILS SHOULD BE EXAMINED AT AN EARLY STAGE IN EVERY ROUTINE EXAMINATION OF THE EYES; CERTAINLY BEFORE ANY MIDRIATIC IS EMPLOYED. NOTE THE SIZE, SHAPE AND POSITION OF THE PUPILS,, ALSO ITS REACTION TO LIGHT ACCOMODATION AND CONVERGENCE.

THE LENS
OPACITIES OF THE LENS IS CALLED CATARACT.

THE CATARACT OPACITIES ARE SEEN BY OBLIQUE ILLUMINATION AS GRAY, WHIFE OR YELLOWISH PATCHES; BY RETRO ILLUMINATION WITH OPHTHALMOSCOPE THEY APPEAR BLACK.

PALPATION GIVES INFORMATION CONCERNING:

(1) (2) (3) TENDERNESS IN THE CILIARY REGION TENSION OF THE EYEBALL EXISTENCE OF TUMOR

INTRA OCULAR PRESSURE THE TENSION OF THE GLOBE MAY BE ESTIMATED BY PALPATION.

FOR ACCURATE MEASURMENT OF THE INTRAOCULAR PRESSURE USE THE TONOMETER SCHIOTZ.

TONOMETRY BY TONOMETER SCHIOTZ

- THE EYE IS ANESTHETIZED. WITH TWO INSTILLATION OF PANTOCAINE. - THE PATIENT SHOULD LIE ON A COUCH, THE EYES DIRECTED UPWARD. - THE LIDS ARE SEPARATED WITH THE FINGERS WITHOUT PRESSING ON THE EYE BALL.

-THE TONOMETER IS ALLOWED TO REST BY ITS OWN WEIGHT ON THE CENTER OF THE CORNEA. - THE NEEDLE OF THE INSTRUMENT BECOMES DEFLECTED TO A CERTAIN NUMBER WHICH AN ACCOMPANYING SCALE TRANS LATES INTO A DEFINITE NUMBER OF MILLIMETERS OF MERCURY. - THE MEAN NORMAL INTRAOCULAR PRESSURE IS 16.1 OF Hg., WITH STANDAR DEVIATION OF + 2.8 MM.

THE OFHTHALMOSCOPIC EXAMINATION

BEFORE ATTEMPTING TO SEE THE FUNDUS, THE MEDIA MUST BE EXAMINED. EXAMINATION WITH OPHTHALMOSCOPE AT A DISTANCE.

THE DISTANCE BETWEEN PATIENT AND EXAMINER IS ABOUT 15 INCHES.

- THIS METHOD EXPLORES ALL THE MEDIA:

CORNEA, AQUEOUS LENS AND VITREUS. - IN THE NORMAL EYE A HOMOGENEDUS ORANGE RED REFLEX ISOBTAINED.(FUNDUS REFLEX.)

-IF OPACITIES EXIST IN ANY OFTHEMEDIA, THEY WILL APPEAR AS DARK OR BLACK SPOTS UPON THE COLORED BACKGROUND OF THE PUPIL.

THE DIRECT METHOD OF OPHTHALMOSCOPIC EXAMINATION.

@ THE EXAMINER SITS OR STANDS
TO THE SIDE OF AND FACING THE PATIENT. @ THE OPHTHALMOSCOPE Is BROUGHT DIRECTLY IN FRONT OF THE PATIENT'S EYE AS CLOSE AS POSIBLE (NOT MORE THAN 1 INCH) @ FOR EXAMINATION OF THE RIGHT EYE, THE EXAMINER MUST BE ON THE RIGHT SIDE AND THE OPHTHALMOSCOPE MUST BE PLACED BEFORE THE RIGHT EYE OF THE OBSERVER. @ WHEN THE LEFT EYE IS BEING EXAMINED THE EXAMINER MUST BE TO THE LEFT, AND USE HIS LEFT EYE.

THE INDIRECT METHOD OF OPHTHALMOSCOPIC EXAMINATION.

- WITH INDIRECT METHOD THE IMAGE IS INVERTED AND MAGNIFIED ABOUT FOUR DIAMETERS. - A STRONG CONVEX LENS (+ 20.00 D) IS HELD ABOUT ITS FOCAL DISTANCE IN FRONT OF THE EYE TO BE EXAMINE (2 TO 3 INCHES)

THE DIRECT AND INDIRECT

THE DIRECT METHOD GIVE AN ERECT IMAGE WHICH IS HIGHLY MAGNIFIED (ABOUT 15 X). A SMALL PORTION OF THE FIELD IS SEEN AT A TIME.

THE INDIRECT METHOD GIVES A LARGER FIELD OF VIEN, MAGNIFICATION IS SMALLER (A BOUT 4 X) THE IMAGE IS INVERTED.

THE NORMAL FUNDUS

IT PRESENTS AN ORANGE - RED SURFACE UPON WHICH THE DISK, THE BLOOD VESSELS AND THE MACULA ARE DISTINGUISHED.

THE DISK (PAPILLA.)

REPRESENT THE ENTRANCE OR HEAD OF THE OPTIC NERVE; IT USUALLY IS CIRCULAR, BUT SOMETIMES OVAL IN FORM. ITS COLOR IS LIGHT PINKISH THE MARGIN IS SHARLY DEFINED. THE CENTER OF THE PAPILLA PRESENTS A FUNNEL-SHAPED DEPRESSION FORMED BY THE SEPARATION OF THE NERVE FIBERS ; THIS APPEAR WHITER THAN THE REST OF THE DISK ----> PHYSIOLOGIC DEPRESSION OR CUP.

THE CENTRAL ARTERY AND VEIN OF THE RETINA.

- PASS ALONG THE INNER WALL OF THE EXCAVATION.
- UPON REACHING THE SURFACE OF THE DISK USUALLY DIVIDE INTO SUPERIOR AND INFERIOR DIVISIONS. -EACH OF THESE SOON DIVIDES GIVING OFF NASAL AND TEMPORAL BRANCHES.

THE REGION OF THE MACULA LUTEA.

- IT IS THE MOST IMPORTANT PART OF THE FUNDUS. -SITUATED LESS THAN TWO DISK DIAMETERS TO THE TEMPORAL SIDE OF THE DISK. -IN THE LINE OF DIRECT VISION. -IT IS DEVOID OF VISIBLE VESSELS. -DARKER THAN THE REST OF THE FUNDUS. -A BRIGHT SPOT IS SEEN IN ITS CENTER CORRESPONDING TO THE POSITION OF THE FOVEA CENTRALIS.

Selected Reference Books

DANIEL VAUGHAN, TAYLOR ASBURY GENERAL OPHTHALMOLOGY 15 Th. Ed. LANGE MEDICAL PUBLICATION,LOS ALTOS, CALIFORNIA. 1998. STEPHEN J H MILLER, PARSONS' DESEASES OF THE EYE EIGHTEENTH EDITION CHURCHILL LIVINGSTONE LONDON,MELBOURNE, AND NEW YORK 1990. JACK J KANSKI, KEN K NISCHAL OPHTALMOLOGY, CLINICAL SIGNS AND DIFFERENTIAL DIAGNOSIS, MOSBY, LONDON. 1999