retinal conditions
TRANSCRIPT
Ophthalmology 101ver1
Fundal changes in common Fundal changes in common ophthalmologic conditionsophthalmologic conditionsA self-directed fundoscopy tutorial A self-directed fundoscopy tutorial for 4for 4thth year medical students year medical studentsEditorsEditors
Debby VugtsDebby VugtsLisette WijdemansLisette WijdemansAnselm Ong (MB ChB)Anselm Ong (MB ChB)
Design, Illustration & “eye-con” ArtworkDesign, Illustration & “eye-con” ArtworkAnselm Ong (MB ChB)Anselm Ong (MB ChB)
SupervisorSupervisorGordon SandersonGordon Sanderson
Normal fundus
Optic disc Optic cup
Macula
Superior temporal vein
Superior nasal vein
Inferior temporal vein
Inferior nasal vein
Superior temporal artery
Fovea
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0.7
What is the cup to disc ratio?
What does the arrow show?
notching of the neuroretinal rim
disc
cup (look at the bending point of the small vessels)
What is the cup to disc ratio?
0.5
What phenomenon does the arrow show?
Flasking (vessels disappear from view after turning into the cup)
These discs are from the same patient. How would you describe the discs?
They are asymmetrical
What is your provisional diagnosis?
Open-angle glaucoma
Peripapillary atrophy (as a result of aging)
Why is this a glaucomatous cup?
Vertical elongation of the cupISNT rule (thinning of the rim in the following order: inferior,
superior, nasal, temporal)
What does the arrow indicate?
Lamina Cribrosa
Bayonetting (quick angulation in the course of the blood vessels as they exit the nerve)
What do these arrows indicate?
Dilated vein
Describe what you seeWhat systemic disease are these signs
associated with?
Microaneurysm
Diabetes Mellitus
Hard exudates Hard
exudates
Blot haemorrhage
Flame haemorrhage
Describe these fundal abnormalities
Microaneurysm
What condition are these changes characteristic of?
Non proliferative diabetic retinopathy
Note: flame haemorrhages tend to be more common in hypertensive retinopathy
Hard exudates
Blot haemorrhage
Blot haemorrhage
Blot haemorrhage
Neovascularisation of the optic disc
Dot haemorrhage
MicroaneurysmFibrovascular
tissue secondary to longstanding neovascularisation
Describe the fundus
What is your diagnosis?
Proliferative diabetic retinopathy
What has happened here?
Pan Retinal Photocoagulation (PRP)PRP is used in the treatment of proliferative diabetic
retinopathy
Macular star
What are these arrows pointing at?
What condition is this feature associated with?
Hypertension
Cotton wool spot
Blot haemorrhage
Papilloedema
Hard exudates
AV crossing change
Flame haemorrhage
Describe the fundal abnormalities
What condition are these features characteristic of?
Preretinal haemorrhage
Severe hypertensive retinopathy
What is your diagnosis?
Branch Retinal Vein Occlusion (BRVO)
Which vein is affected? What is the characteristic feature of this condition?
Inferior temporal vein; lesion does not cross horizontal midline of the fundus
What is your diagnosis?
Central Retinal Vein Occlusion (CRVO)
Blood supply from the choroidal arteries (Cherry Red Spot)
Blood supply from cilioretinal artery
Note: Only 5% of the population will have a cilioretinal artery; therefore in most CRAOs only the Cherry Red Spot is seen
What has happened to this fundus?
Central Retinal Artery Occlusion (CRAO)
Why are there still areas of redness?
Blood supply from the cilioretinal artery and choroidal arteries are still intact
Describe the fundal changes
What is your diagnosis?
Hyperpigmentation and drusen of the macula
Dry Age Related Macular Degeneration (ARMD)
What is the name of this type of macular degeneration?
Disciform macular degeneration/ Wet ARMD
What types of lesion are these ?
What is the most likely cause of this lesion?
Chorioretinal scars
Toxoplasmosis
Old lesion
Active lesion
What is happening here?
Retinal detachment
What retinal pathology is present?
Retinitis pigmentosa
Is this a neavus or melanoma?
Is this a neavus or melanoma?
MelanomaMelanoma NaevusNaevusBigBig SizeSize SmallSmallMulticolouredMulticoloured ColourColour Single colourSingle colourIrregularIrregular EdgesEdges DistinctDistinctElevatedElevated ThicknessThickness FlatFlat
How can you differentiate between these two lesions?
What is your diagnosis?
Melanoma Naevus
What is wrong with this optic disc?
Papilloedema
#1 #2
Compare the 2 optic discs. Which is the healthy disc?
#2
What is the optic disc abnormality in #1?
Optic atrophy
The end