Welch Allyn To The Use Of Diagnostic Instruments In Eye And Ear Examinations Quick Reference Guide

Advancing Frontline Care

4341 State Street Road, P.O. Box 220, Skaneateles Falls, NY 13153-0220 USA

(P) 800-535-6663 (F) 315-685-3361 www.welchallyn.com

Advancing Frontline Care

A Guide to the Use of

Diagnostic Instruments in Eye and Ear Examinations

Contents

The Eye

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

The Otoscope 20

How to Conduct an Otoscopic Examination 22

Pneumatic Otoscopy 24

Common Pathologies of the Ear 25

Other Ear Care 31

Advancing Frontline Care

About Welch Allyn: Welch Allyn, Inc. was founded in 1915 and is today a leading manufacturer of innovative

medical diagnostic and therapeutic devices, cardiac defibrillators, patient monitoring systems, and miniature

precision lamps. Headquartered in Skaneateles Falls, New York, USA, Welch Allyn employs more than 2,300

people and has numerous manufacturing, sales, and distribution facilities located throughout the world.

Additional information on Welch Allyn and its products may be found at www.welchallyn.com.

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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. In this sense, the eye serves as a window through which many valuable clinical evaluations may be made.

When a preliminary diagnosis of an imminently dangerous eye condition, such as acute glaucoma or retinal detachment, is made by the examiner, prompt referral to an ophthalmologist may prevent irreversible damage. Or, when distressing but less urgent conditions, such as visual impairment due to cataract or vitreous floaters are recognized, the patient can be reassured and referred.

Welch Allyn ophthalmoscopes, with their bright, white halogen illumination coupled with their patented optical system, allows the examiner to clearly see these important structures of the eye to aid in making the correct diagnosis.

Little has been written giving the practitioner detailed instructions on the use of the ophthalmoscope. Because the examination can give so much information about a patient’s well being, correct use of the ophthalmoscope makes it one of the most valuable tools available for diagnostic use. The following pages in this section contain information on ophthalmoscopes, how to conduct an ophthalmic exam, and what to look for while examining the eye.

NORMAL FUNDUS

Optic Disc

Physiological Cup

Macula

Vein

Artery

A- Macula B- Vitreous Humor C- Sclera D- Choroid E- Retina F- Ora Serrata G- Canal of Schlemm H- Anterior Chamber I- Iris

J- Cornea K- Ciliary Body L- Zonule (suspensory Ligament) M- Conjuctiva N- Lens O- Hyaloid Canal P- Central Retinal Vein Q- Optic Nerve R- Central Retinal Artery

Welch Allyn PanOptic

Ophthalmoscope Welch Allyn Coaxial Ophthalmoscope

The Welch Allyn PanOptic Ophthalmoscope described in this section incorporates a patented* Axial PointSource™ optical system. The new 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. The viewing system enables the operator to view the illuminated area on virtually the same axis, thus creating the widest field of view attainable in undilated ophthalmoscopy.

The PanOptic has a focusing range from -20 to +20 diopters. The Dynamic Focusing Wheel adjusts the focus in a continuous, smooth action for more precise control and optimum view. This helps compensate for patient or examiner refractive error, the position of the ophthalmoscope and the changes in viewing requirements necessitated by focusing on different points within the eye.

The patient side eyecup helps the practitioner establish and maintain the proper viewing distance and provides stabilization for the view during the exam. It also serves as the pivoting point for leverage in panning around the retina. While in contact with the patient, the eyecup occludes ambient light, eliminating interference from other light sources.

ADDITIONAL USES FOR THE PANOPTIC OPHTHALMOSCOPE

In addition to examination of the fundus, the ophthalmoscope is a useful diagnostic aid in studying other ocular structures. The light beam can be used to illuminate the cornea and the iris for detecting foreign bodies in the cornea and irregularities of the pupil.

The PanOptic Ophthalmoscope features a Cobalt Blue Filter and add-on Corneal Viewing Lens (model 11820 only), which together can be used along with fluorescein dye applied to the cornea to look for abrasions and foreign bodies on the cornea.

To attach the Corneal Viewing Lens:

1. Remove the patient eyecup.

2. Push and twist on the lens in place of the eyecup, until the bottoms ribs catch.

Refer to Pages 8 and 9 to learn how to conduct an ophthalmic exam with the PanOptic ophthalmoscope.

*U.S. PATENT NOS. 6,637,882; 6,527,390

Welch Allyn Coaxial ophthalmoscopes incorporate a patented* coaxial optical system, allowing the axis of illumination to be coincidental with the axis of vision into the retina, thereby eliminating annoying shadows and facilitating examination through virtually any size pupil or vitreous disorder. The fundus and interior anatomy of the eye are viewed with precision and clarity.

Welch Allyn scopes offer a wide choice of 28 viewing lenses, ranging from –25 to +40 diopters, with fast, accurate one-hand selection. This helps compensate for patient or examiner refractive error, the position of the ophthalmoscope and the changes in viewing requirements necessitated by focusing on different points within the eye.

Some coaxial models offer an additional crossed linear polarizing filter/ red-free filter switch increases the versatility of this instrument. When used in conjunction with available apertures, the coaxial ophthalmoscope yields 15 possible apertures.

The illuminated lens dial enables the practitioner to check the lens being used for a particular examination even in a darkened examination room.

The brow rest allows the practitioner to use his/her own eyeglasses comfortably and safely. It also steadies the instrument while in use.

ADDITIONAL USES FOR THE COAXIAL OPHTHALMOSCOPE

Refer to Pages 8 and 9 to learn how to conduct an ophthalmic examination with the Coaxial ophthalmoscope.

When used correctly and regularly, the Welch Allyn ophthalmoscope is one of the most effective diagnostic instruments available.

*U.S. PATENT NOS. 4,998,818; 4,526,449

APERTURES AND FILTERS

There is a wide range of practical apertures and filters to select from on both the PanOptic and Coaxial ophthalmoscopes: small spot, large spot, micro spot, slit aperture, red-free filter, cobalt blue filter, half-moon, and fixation aperture. This selection of apertures covers all the practitioner’s

basic needs in an ophthalmoscope.

Micro Spot Aperture: Allows easy

entry in very small, undilated pupils.

Slit Aperture: Helpful in determining

various elevations of lesions, particularly tumors and edematous discs.

Aperture Dial

PanOptic Soft Grip

Front surface mirror

Crossed linear polarizing filter/red-free filter switch

Aperture selection dial

Dynamic Focusing Wheel

Patented* Glare Extinguishment

Patient Eyecup

Rubber brow rest

Lens selection disc

Illuminated lens indicator

On/Off switch and rheostat control

Practitioner SidePatient Side

Small Aperture: Provides easy view of the fundus

through an undilated pupil. Always start the examination with this aperture and proceed to micro aperture if pupil is particularly small and/or sensitive to light.

Large Aperture: Standard aperture for dilated pupil

and general examination of the eye.

Half-Moon Aperture (PanOptic Model

11810 only): Provides a combination of depth perception and field-of view.

Fixation Aperture

(Coaxial Model only): The pattern of an open center and thin lines permits easy observation of eccentric fixation without masking the macula.

Cobalt Blue Filter: Blue filter used

with fluorescein dye permits easy viewing of small lesions, abrasions, and foreign objects.

Red-Free Filter:

Excludes red rays from examination field for easy identification of veins, arteries, and nerve fibers.

How to Conduct an Ophthalmologic Examination with the PanOptic

Ophthalmoscope

1. Take the PanOptic ophthalmoscope in your right hand with the Practioner’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.

2. Set the Aperture/Filter Dial to the small spot (green line).

3. Dim the room lights. Instruct the patient to look straight ahead at a distant object.

4. Hold the PanOptic up to your eye and position the ophthalmoscope about 6 inches (15cm) in front and at a slight angle (15 to 20 degrees) on the temporal side of the patient. Direct the light beam into the pupil. A red “reflex” should appear as you look through the pupil.

5. Rest your left hand on the patient’s forehead and hold the upper lid of the eye near the eyelashes with your thumb. While the patient is fixating on the specified object, keep the red “reflex” in view and slowly move toward the patient. Follow the red reflex into the pupil until the PanOptic eyecup rests on the orbit of the patient’s eye. The trip from 6 inches away to making contact must be one that is slow, deliberate, and steady.

The optic disc should come into view when you are about 1 to 2 inches (3-5cm) from the patient. Gentle compression of the eyecup will maximize the field of view.

If the optic disc is not focused clearly, rotate the Dynamic Focusing Wheel with your thumb until the optic disc is as clearly visible as possible. The hyperopic, or far-sighted, eye requires more “plus” (rotation towards green) focus for clear focus of the fundus; the myopic, or near-sighted, eye requires “minus” (rotation towards red) focus for clear focus.

If you lose the view of the optic disc while approaching the patient’s eye, pull back slowly, relocate the red reflex, and try again.

6. Now examine the disc for clarity of outline, color, elevation and condition of the vessels. Follow each vessel as far to the periphery as you can.

7. To view the macula, instruct your patient to look directly into the light of the ophthalmoscope. This will automatically place the macula in full view. An alternative technique is to have your patient fixate straight ahead. Attain the red reflex from a 15º angle at 6 inches away from the patient’s eye. When the PanOptic is 3 inches from contact, instruct the patient to look into the light while the patient is still facing straight ahead. Continue moving towards the patient until the eyecup reaches the orbit of the patient.

Look for abnormalities in the macula area. The red-free filter facilitates viewing of the center of the macula.

8. To examine the extreme periphery, instruct the patient to fixate straight

ahead while performing the examination. Pivot around the eye by leveraging the eyecup against the orbit of the patient’s eye to achieve the desired view. It is important to compress the eyecup to maximize this technique. Without full compression, the chances of losing your view increase significantly.

This routine will reveal almost any abnormality that occurs in the fundus.

9. To examine the left eye, repeat the procedure outlined above.

ADDITIONAL EXAMS WITH THE PANOPTIC OPHTHALMOSCOPE

To look for abrasions and foreign bodies on the cornea with the corneal viewing lens, no contact is made between the ophthalmoscope and the patient.

Begin the exam about 6 inches from the patient with the focus wheel in the neutral position.

Look through the scope at the patient’s cornea to direct the light at the target area.

Adjust the focus wheel into the green (plus) diopters while moving slightly in (closer) or out (further) until a comfortable working distance and magnification of the cornea is achieved.

The following steps will help the practitioner obtain satisfactory results with the PanOptic Ophthalmoscope:

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