Fundoscopy revision

Normal fundus

> Colour = pink

> Clear contour

> Normal cup

> No haemorrhages/deposits etc

> Retina in all positions

Diabetic Retinopathy - BACKGROUND

➢ Non proliferative, no neo-vascularisation

➢ Usually asymptomatic

➢ Occurs in almost everyone with DM in 8-10years

➢ Microaneurysms, retinal haemorrhages (dot/blot),

exudates, cotton wool spots (nerve fibre degeneration),

vascular calibre changes and intraretinal microvascular

abnormalities.

➢Exudates are yellow areas where lipid has

leaked from damaged vessels.

Proliferative DR

➢Significant retinal ischaemia (more

common in T1DM) triggers neo-

vascularisation on the optic disc or retina.

➢Small tufts of irregular vasculature

➢ Initially flat then progress and protrude

into the vitreous

Retinal detachment

➢Medical emergency as complete

detachment causes blindness

➢Usually after post vitreous detachment

(flashes and floaters) or associated with

DM.

Diabetic maculopathy

➢DR with macula involvement - more

common in T2DR

➢Focal, diffuse, ischaemic - all referring to

haemorrhages of microvasculature

Diabetic Retinopathy treatment

Laser - focal or grid. Lasering the macula

will blind the patient.

Control diabetes and cardiovascular risk

factors.

Macular Degeneration

➢Age related (>50yo)

➢Bilateral

➢Progressive central scotoma

➢Dry (atrophy) V. Wet (Neovasculature)

DRY MD

➢Atrophy of the RPE and choroid

➢Pigmentary changes

➢Drusen - yellow/white accumulates that

deposit between Bruch’s membrane and

the RPE. Tends to be seen around the

macula

➢More common that wet MD, les

debilitating

Wet MD

➢10% of MD but the severe type

➢New blood vessels form under the retina

and leak/bleed/scar

➢OCCULT AMD is when the new vessels

stay within Bruch’s membrane, CLASSIC

AMD is when the vessels penetrate

through Bruch’s membrane

Glaucoma

➢Progressive optic neuropathy

➢Peripheral visual field loss

➢Ganglion cells of the optic nerve die

causing cupping

➢The cup thins ~0.8 and no longer follows

the ISNT rule

Types of glaucoma?

1. Primary open angle - associated with

family history, age and myopia.

Asymptomatic unto field defect.

2. Primary acute angle closed - red eye,

nausea/vomiting, acute pain

3. Secondary

Papilloedema

➢Bilateral swelling of the optic disc

➢Due to increased intracranial pressure

➢Blurring of the optic disc margins

Giant cell arteritis

➢ An immune mediated vasculitis

➢ Jaw claudication, scalp tenderness, headache, fever,

bruis, possible blurred/double/lost vision

➢ Associated with polymyalgia rheumatica

➢ High dose steroids prevent blindness

➢ Causes optic atrophy (pale optic disc) and swelling of

the optic disc. Also arterial occlusions

Optic atrophy

Seen with

➢Optic neuritis (recurrent indicates MS)

➢Giant cell arteritis

➢Foster kennedy (anosmia, central

scotoma, optic atrophy and papilloedema

due to frontal lobe tumour)

Central retinal artery occlusion

➢Sudden painless LOV

➢Typically due to emboli

➢Cherry red spot

Central retinal vein occlusion

➢May also be a branch occlusion

➢Due to thrombosis/atherosclerosis

➢Sudden painless LOV

➢Flame hemorrhages