Fundoscopy: as a clinical diagnostic tools in Paediatric Practice

Abstract

Direct fundoscopy is an easy, quick useful and rleiable aspect of neurological examination, yielding positive clues to the diagnosis of intracranial pathologies. To ascertain its significance in paediatric practice, a prospective study was done, in the paediatric department of Postgraduate Medical Institute, Lady Reading Hospital Peshawar. The study stretched over two years 01/01/1996 to 31/12/1997. Total admission over the study period were 3168. Out of them 120 cases with neurological and fundoscopic findings were included in the study. Besides routine investigations, lumber and CAT scanning was performed in relevant cases. Fudoscopy was performed in the standard technique described by Huismans[4]. The ages of the patients varied from 5 months to 14 years and included 69 males and 51 females. These patients were diagnosed as septic meningitis (58 cases), aseptic meningitis (22 cases), tuberculous meningitis (20 cases), hypertensive encephalopathy (10 cases), intracranial space occupying lesions (6 cases), near drowining (2 cases) and head injury with intracranial bleed (1 case). The major fundoscopic findings included engorgement of blood vessels (57 cases), fundus hyperemia (36 cases), pappiloedema (26 cases), retinal haemorrhages (10 cases), optic atrophy (3cases) and choroid tubercle(1 case). The various funduscopic findings, their mechanism and relation with different diseases in described in the light of available literature. Fundoscopy remains as a very useful non invasive clinical tools and it should be an integral part of all neurological evaluations done in paediatric practice.