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Show ' oumal of Clill/ cal Neuro- ol'hthalmology lOr 1I. 76- 78, 1990 Letters to the Editor Bedside Monocular Indirect Ophthalmoscopy To the Editor: Neuro- ophthalmologists frequently perform fundus examinations at the bedside, Occasionally, I am unable to see fundus details with the direct ophthalmoscope, This is due either to hazy media or to high refractive errors. In these cases I have found it very useful to use a method of monocular indirect ophthalmoscopy, The Welch Allyn Finoff transilluminator with fiberoptic light source provides bright and uniform illumination, I use this light source and a 20- diopter aspheric lens to perform monocular indirect ophthalmoscopy, as follows: Hold the transilluminator with the right hand and shine the light into the pharmacologically dilated pupil, With the left hand, hold the lens ( Fig. 1) about 10- 15 cm from the patient's eye, Then move the lens backward and forward until one can see clear fundus details, I have found this method very helpful, especially in cases with corneal opacity such as a corneal leukoma or due to recently applied ocular ointment, cataracts, or vitreous hemorrhage that FIG. 1. Hold the transilluminator with the right hand and shine the light into the pharmacologically dilated pupil. With the left hand, hold the lens about 10- 15 cm from the eye. Move it until clear fundus details are visible 76 © 1990 Raven Press, Ltd., New York would not allow good fundus examination with the direct ophthalmoscope. Naturally this method serves only as a quick check, and if an abnormal finding is seen I would perform conventional binocular indirect ophthalmoscopy. The principle of monocular indirect ophthalmoscopy is well known, and any bright beam could serve as a light source. My experience with this simple method is excellent, and I would like to recommend it to colleagues. Benjamin Hartmann, M. D. Neuro- ophthalmology Service Department of Ophthalmology Henry Ford Hospital Detroit, Michigan Hysterical Bitemporal Hemianopia " Cured" with Contact Lenses To the Editor: Recently, an 18- year- old woman had sudden onset of decreased peripheral vision in both eyes, Her past medical history was unremarkable. The patient had had one previous episode of " tunnel vision" 2 years previously. Complete physical and neurological examination results were normal. Corrected visual acuity was 20/ 20 OU, Refractive error was 00, - 0.50 sphere; OS, - 0,75 + 0.25 x 88, The remainder of the ophthalmologic examination, including pupils, extraocular movements, and funduscopic examination, was normal. Automated perimetry demonstrated a bitemporal hemianopia ( Fig, 1), Goldmann perimetry and tangent screen testing confirmed these findings but showed inconsistencies in the borders of the defects along the vertical meridian ( Fig. 2.) Cranial computed tomography and pattern reversal visual evoked responses were normal. The patient expressed interest in contact lenses and was fitted |