Thorough knowledge about the basic ophthalmic examination is instrumental in the emergency department (ED) to determine the severity of eye emergencies and to develop a plan for treatment, including the possible need for an ophthalmology consultation. The direct ophthalmoscope is undoubtedly the most practical instrument available to a pediatric emergency physician for ophthalmic examination. However, the information elicited by its use is dependent on the quality of the instrument and the competency of the user. A greater understanding of the range of possibilities of the direct ophthalmoscope as a diagnostic tool will facilitate more efficient care of the pediatric patient.