A Guide to the Use of Diagnostic Instruments in Eye and Ear Examinations
Contents Sponsored by The Eye 4 The PanOptic™ Ophthalmoscope 6 The Coaxial Ophthalmoscope 7 How to Conduct a PanOptic Ophthalmologic Exam 8 How to Conduct a Coaxial Ophthalmologic Exam 10 Common Pathologies of the Eye 12 The Ear 18 The Otoscope 20 How to Conduct an Otoscopic Examination 22 Pneumatic Otoscopy 24 Common Pathologies of the Ear 25 Other Ear Care Products 31 About Welch Allyn: Welch Allyn, Inc.
The Eye Transparency of the cornea, lens and vitreous humor permits the practitioner to directly view arteries, veins, the optic nerve and the retina. Direct observation of the structures of the fundus through an effective ophthalmoscope may show disease of the eye itself or may reveal abnormalities indicative of disease elsewhere in the body. Among the most important of these are vascular changes due to diabetes or hypertension and swelling of the optic nerve head due to papilledema or optic neuritis.
PanOpticTM Ophthalmoscope The Welch Allyn PanOptic Ophthalmoscope incorporates a patented* Axial PointSource™ optical system. The optics system converges the light to a point at the cornea, which allows the practitioner easy entry into small pupils. The illumination pathway then diverges to the retina, illuminating a very wide area of the fundus.
How to Conduct an Ophthalmologic Examination with the PanOpticTM Ophthalmoscope The following steps will help the practitioner obtain satisfactory results with the PanOptic Ophthalmoscope: 1. Take the PanOptic ophthalmoscope in your right hand with the Practitioner's Side facing you and place your thumb on the Focusing Wheel. Hold the instrument up to your right eye and look through the eyepiece. By rotating the Focusing Wheel with your thumb, focus the instrument on an object approximately 20 feet away.
How to Conduct an Ophthalmologic Examination with a Coaxial Ophthalmoscope In order to conduct a successful examination of the fundus, the examining room should be either semidarkened or completely darkened. It is preferable to dilate the pupil when there is no pathologic contraindication, but much information can be obtained through the undilated pupil. The following steps will help the practitioner obtain satisfactory results: 1. For examination of the right eye, sit or stand at the patient’s right side.
Common Pathologies of the Eye NORMAL FUNDUS CENTRAL RETINAL VEIN OCCLUSION Disc: Outline clear; central physiological cup is pale Disc: Virtually obscured by edema and hemorrhages Retina: Normal red/orange color, macula is dark; avascular area temporally Retina: Extensive blot retinal hemorrhages in all quadrants to periphery Vessels: Arterial/venous ratio 2 to 3; the arteries appear a bright red, the veins a slightly purplish color Vessels: Dilated tortuous veins; vessels partially obscured by
Common Pathologies of the Eye PROLIFERATIVE DIABETIC RETINOPATHY MACULAR DRUSEN (COLLOID BODIES) Disc: Net of new vessels growing on disc surface Disc: Normal Retina: Numerous hemorrhages, new vessels at superior disc margin Retina: Extensive white drusen of the retina Vessels: Normal Vessels: Dilated retinal veins END STAGE DIABETIC RETINOPATHY INACTIVE CHORIORETINITIS (TOXOPLASMAS) Disc: Partially obscured by fibrovascular proliferation Disc: Normal Retina: Obscured by proliferating tis
Common Pathologies of the Eye RETINAL DETACHMENT OPTIC NEURITIS Disc: Normal Disc: Elevated with blurred margins Retina: Gray elevation in temporal area with folds in detached section Retina: Mild peripapillary edema Vessels: Mild dilation of vessels on disc Vessels: Tortuous and elevated over detached retina BENIGN CHOROIDAL NEVUS OPTIC ATROPHY Disc: Normal Disc: Margins sharp and clear; pale white color Retina: Slate gray, flat lesion under retina; several drusen overlying nevus Retina
The Ear Since symptoms of ear disease are relatively few in number and frequently nonspecific, a clinical examination of the ear is important in the management of ear disorders. Semicircular Canals Incus When a patient complains of ear pain, examination of the ear is indicated to differentiate whether the patient’s disorder is an ear infection or a disorder originating in adjacent structures, such as the tempomandibular joint, the teeth or the tonsils.
MacroViewTM Otoscope The Welch Allyn MacroView otoscope features a patented optical system that provides the practitioner with an increased field of view and magnification to get a large, clear image of the tympanic membrane. Welch Allyn’s traditional diagnostic otoscopes feature a wide-angle magnified viewing lens.
How to Conduct an Otoscopic Examination 5. There are two common ways to hold the otoscope. The first way is to hold the otoscope like a hammer by gripping the top of the power handle between your thumb and forefinger, close to the light source. You can conveniently hold the bulb of the pneumatic attachment between the palm of the same hand and the power handle. It is recommended that you extend the middle and ring finger outward so they come into contact with the person’s cheek.
Pneumatic Otoscopy Pneumatic otoscopy provides practitioners with a simple method for determining tympanic mobility and helps then recognize many middle ear disorders. It is the pneumatic capability and insufflator attachment of the otoscope which enable the examiner to assess the mobility of the intact tympanic membrane.
Common Pathologies of the Ear 26 FOREIGN BODY OTOMYCOSIS A varied selection of foreign bodies has been discovered in the ear canals of children. In this case, a large piece of sponge rubber was removed. In adults, a forgotten piece of cotton wool is frequently found. The foreign body or an unsuccessful attempt to remove it can both product secondary otitis externa or damage to the tympanic membrane and ossicles. In young children, it is sometimes safer to administer a short, general anesthetic.
Common Pathologies of the Ear TYMPANOSTOMY TUBE (RIGHT EAR) A tympanostomy tube is often inserted into the tympanic membrane to ventilate the middle ear in cases of chronic serous otitis media. These tubes come in a variety of sizes, shapes and materials. The tympanostomy tube should be seen to be in place in the tympanic membrane with its lumen patent and free of any exudate or debris.
Common Pathologies of the Ear Other Ear Care Products ADHESIVE (ATROPHIC) OTITIS MEDIA (LEFT EAR) Following long-standing eustachian tube obstruction, the tympanic membrane may become atrophic and retracted onto the medial wall of the middle ear and ossicles, thereby obliterating the middle ear space. In this case, a thin atrophic tympanic membrane is draped over the head of the stapes and the tip of the long process of the incus has been eroded.
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