All procedures
GMC #03/Assessment of patient needs taught Y3
Direct ophthalmoscopy
Perform basic ophthalmoscopy and identify common abnormalities.
Target · Perform independently0% ready
Do it yourself on a patient, with support available if you need it — the GMC’s highest new-grad level (“indirect supervision”).
Overview
Fundoscopy — a discriminating FY1 skill and directly relevant to the ophthalmology-adjacent presentations (red eye, sudden vision loss). Master the systematic sweep: red reflex → optic disc → vessels → macula.
Indications
- Assessing the red reflex (cataract, retinoblastoma in children)
- Diabetic & hypertensive retinopathy
- Papilloedema (raised ICP)
- Sudden visual loss (central retinal artery/vein occlusion)
Contraindications & cautions
- Avoid pharmacological dilation if angle-closure glaucoma is a risk, or where pupillary responses must be monitored (e.g. head injury) — always ask before dilating
Equipment
Direct ophthalmoscope (check the light and battery)Mydriatic drops (e.g. tropicamide 1%) if dilation permittedA darkened room
Step by step
Prepare
- 1Dim the lights; dilate the pupil if appropriate and consented
- 2Set the ophthalmoscope to 0 dioptres; ask the patient to fix on a distant point
Examine
- 1Use your right eye/hand for the patient’s right eye (and left for left)
- 2Elicit the red reflex from ~arm’s length
- 3Approach ~15° temporally, following a blood vessel back to the optic disc
- 4Assess the disc — colour, margins, cup:disc ratio
- 5Follow the four vascular arcades; assess AV nipping/haemorrhages/exudates
- 6Finally ask the patient to look at the light to view the macula
Complications
- None significant; transient dazzle. Pharmacological dilation blurs vision for hours — warn re: driving.
OSCE tips
- Right-to-right, left-to-left — getting the wrong eye/hand loses easy marks.
- An absent red reflex is a red flag (cataract; leukocoria = retinoblastoma in a child).
- Comment on the disc systematically; “I would ideally dilate for a full view” shows good practice.
Watch
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Sources & credits
Authored to UK finals standard and verified against UK guidance (NICE · BNF · Resuscitation Council UK · BTS) and Geeky Medics OSCE guides . Southampton teaching materials © University of Southampton. Always follow current local policy.