BACKGROUND–Ophthalmoscopy allows for direct visualization of the central nervous system and close inspection of arterioles and venules. Available since the last part of the 18th century, the skills of ophthalmoscopy and the fundus appearance are not commonly well taught.REVIEW SUMMARY–This review will focus on ophthalmoscopy for the neurologist and, more specifically, direct ophthalmoscopy. Observation of the fundus is a difficult examination to perform. This review will serve to provide helpful techniques to become more proficient with the direct ophthalmoscope as well as demonstrate a selection of normal and abnormal ophthalmoscopic findings pertinent to the clinical neurologist.CONCLUSIONS–The ophthalmoscope is an invaluable instrument for the diagnosis of disease. Learning to properly use the direct ophthalmoscope to recognize significant ophthalmoscopic changes can be one of the clinician’s best tools to help make a clinical diagnosis.