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SEGMEN ANTERIOR DRAWING
It’s a standard clinical practice worldwide
Follow up is possible only if you can compare with your previous records.
Will help you medico legally
Last but not the least unless you are documenting it you have not probably seen it
correctly(you think you have seen it all but moment you come to draw it you find that
you don’t remember where the break was it at 1 o’clock or 3 o’clock position and so
on). Only when there is need to document your observation skills will vastly improve.
To allay your fears its not time consuming and once you start doing it for every
patient it gets seamlessly integrated into your system and hardly obstructing the flow
of your busy clinical session.
This section deals with methodical documentation of ophthalmology findings using
standard colour coding
Requisite for drawing:
Mainly 6 coloured pencils- black, blue, brown, red, green, orange (alternately you can
keep pen with four coloured refills and brown and orange pencils)
Eraser: to allow modifications of drawing
Some stencils : you can use a circular object
Cornea & Anterior Segment:
Generally corneal pathologies are documented as frontal view and in cross sectional view.
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Following colour coding is generally used to document the findings of anterior segment
1. Black Colour
Drawing For : Limbus
Scars
Degenerations
Foreign bodies
Sutures
Contact lens
Band keratopathy
2. Blue Colour
Blue colour is used to document the following conditions
Oedema,
Small circles for epithelial oedema
Wavy lines to document folds in Descemet’s membrane
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3. Brown Colour
Brown colour is used to document
Pigmentation-iron or melanin
Pupil and iris
4. Red Colour
Red colour is used to document
Blood vessels (see figures)
Rose Bengal staining
Haemorrhages
FUNDUS (RETINAL) DRAWING
Fundus drawing is universally acceptable records of the retinal disease process. It is a
useful reference to monitor the clinical process and also at the time of surgery.
Requisites for Fundus drawing:
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An examination table, indirect ophthalmoscope, 20 D lens, a scleral depressor (or
paper clips etc), coloured pencils (mainly red, blue, green, yellow, black and brown), eraser,
pencil sharpener, fundus drawing charts and a clipboard.
Fundus drawings are drawn in fundus chart. Generally there are three concentric
circles-the innermost circle represent the areas of posterior to the equator, the middle one
represent area in between equator and ora serrata and the outermost circle represent area
anterior to the ora serrata.It is essential to draw the ophthalmoscopic observation in proper
areas corresponding to the fundus. For example a lattice between ora serrata and equator
should be drawn in between the innermost and middle circles. The optic nerve head is drawn
as a small circle. The radial lines numbered in roman numerical used to designate the clock
hours helps us to describe the location and extent of the lesions.
Generally the bottom right hand corner of the chart is kept near the patient’s right
shoulder and this is done to overcome the difficulties arising from the inverted and reversed
images perceived by the observer during indirect ophthalmoscopy.
It is always better to use a lead pencil to sketch the outlines of fundus drawing, as it
can be erased and redrawn. However many a times the fundus drawings are drawn in
prescription pad, outpatient cards and in case sheets of files. It’s better to use a circular stencil
(like small bangle, cap of a container etc.) to draw the fundus as it looks good. The ora serrata
is drawn as described in fig. -- as ora serrata is smoother in temporal side (11 to 5 o’clock in
right eye and 7 to 1 o’clock in left eye). In eyes with mid dilated pupil and nondilated pupil,
the obstructed view of peripheral fundus is indicated by some lines instead of the usual wavy
pattern of drawing ora serrata.
It is better not to use the red colour to denote attached retina in a case of diabetic
retinopathy as it is mandatory to document retinal vessels, dot and blot haemorrhages,
preretinal haemorrhages and microaneurysms with the help of red colour in such cases and
putting them in white background makes the documentation more useful to monitor the
progression of the disease.
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Colour Coding: Here is a big list of colour coding of retinal lesions.
CODING IN RED COLOUR :
Red– solid
Retinal arterioles
Neovascularization
Vascular abnormalities\ anomalies
Vortex veins
Attached retina
Haemorrhages (pre-retinal and intra-retinal)
Open interior of conventional retinal breaks (tears, holes)
Open interior of outer layer holes in retinoschisis
Normal macula is drawn as a red dot
Red-Cross-lined
Open portion of GRT or large dialyses
Inner portion of CRA
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Inner portion of thin areas of retina
Open portion of retinal holes in inner layer of retinoschisis
CODING IN BLUE COLOUR :
Blue- Solid
Detached retina
Retinal viens
Outlines of retinal breaks
Outlines of ora serrata
Meridional,radial, fixed & circumferential folds
VR traction tufts
Retinal granular tags & tufts
Outline of flat neo-vascularization
Outline of lattice degeneration [inner ‘x’]
Outline of thin areas of retina
Intra-retinal cysts [with overlying curvilinear stripes to show configuration]
Blue-cross-lined
Inner layer of retinoschisis
White with or without pressure
Detached parsplana epithelium anterior to seperation of ora serrata
Rolled edges of retinal tears[ curved lines]
Stippled\circled
Cystoid degeneration
Interrupted lines
Outline of change in area or folds of detached retina because of shifting fluid
CODING IN GREEN COLOUR :
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Green-solid
Opacities in the media
Vitreous haemorrhage
Vitreous membranes
Hyaloid ring
IOFB
Retinal operculum
CW spots
Pearls of ora
Outline of elevated NV
Green Stippled\dotted
Asteroid hyalosis
Frosting or snowflakes on cystoid degenerations, retinoschisis,or lattice degeneration
CODING IN GREEN COLOUR :
Brown-solid
Uveal tissue
Pars plana cysts
Ciliary processess
Striae ciliaris
Pigment beneath detached retina
Outline of CRA beneath detached retina
Pigment Epithelial Detachment
Outline of posterior staphyloma
Malignant choroidal melanomas
Edge of buckle beneath detached retina
Choroidal detachment
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CODING IN YELLOW COLOUR
Yellow-solid
Intraretinal oedema
Intraretinal subretinal hard yellow exudate
Deposits in the RPE
Detached maculae in some retinal seperations
Post-PHC retinal edema
Substance of long & short ciliary nerves
Yellow – stippled Drusen
CODING IN BLACK COLOUR
Black-solid
Edge of buckle beneath attached retina.
Outline of CRA.
Hyperpigmentation as a result of previous t\t with Cryo\PHC\Diathermy.
Naevi.
Sheathed vessels.
Outline of Long & Short Post Ciliary vein & nerve.
Pigment in choroid, or pigmented epithelial hyperpigmentation in areas of attached
retina.
Pigmented demarcation lines at attached margin of detached retina or within detached
retina.
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Remember:
Choroidal tumours are drawn in brown colour and retinoblastomas are outlined in
blue and coloured yellow.
While documenting a retinoschisis, the inner layer is generally outlined and cross
lined in blue. While the open retinal holes within inner layer is outlined in blue with
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inner portion cross lined in red, the holes in the outer layer are outlined in blue and
inner layer is coloured red.
Edited by Dr. Franky F Sihombing, FKUSU2001
