Fundoscopy Flashcards
Name the following condition and its underlying cause?
“the difference in pupil size becomes greater in bright light such as when facing a window in daylight, this would suggest that the larger pupil is the pathological one. This is because the normal pupil will constrict in brighter light accentuating the difference in size. If the difference is more pronounced in dim lighting, this would imply the smaller pupil is abnormal as the larger pupil would then dilate while the pathologically small pupil remains the same size.”
asymmetry in pupil size (anisocoria). This may be longstanding and physiological or be due to acquired pathology.
Examples of asymmetry include a larger pupil in oculomotor nerve palsy and a smaller one in Horner’s syndrome.
What is the following sign and what is the underlying cause?
Periorbital erythema and swelling: a feature of preseptal cellulitis (anterior to the orbital septum) or orbital cellulitis (posterior to the orbital septum)
What is the following sign ?
entropion
What can a loss of eye lashes suggest?
loss of eyelashes (can be associated with malignant lesions),
What is the following sign and what is the underlying cause?
Conjunctival injection (redness): this can be diffuse, sectorial or limbal. Dilated inflamed blood vessels can be due to infection, allergy, trauma and inflammation.
What is the following sign and what is the underlying cause?
Staining of the cornea with fluorescein suggests epithelial loss. A dendritic pattern is seen with herpes simplex infection.
What is the following sign and what is the underlying cause?
Anterior chamber: a fluid level may be noted in hyphaema (blood – red in colour) or a hypopyon (inflammatory cells – yellow in colour).
What different discharges may you see from the eye and their underlying causes?
Discharge: watery discharge is typically associated with allergic or viral conjunctivitis or reactive physiological production (e.g. corneal abrasion/foreign body).
Purulent discharge is more likely to be associated with bacterial conjunctivitis.
Very sticky, stringy discharge can suggest chlamydial conjunctivitis while blood staining can be seen with gonococcus.
List 5 painless causes of red eye
Painless red eye:
Conjunctivitis: diffuse conjunctival injection (unilateral or bilateral), discharge, swollen conjunctiva (chemosis) and debris. Bacterial conjunctivitis typically has more purulent discharge than viral or allergic conjunctivitis.
Subconjunctival haemorrhage: a flat, bright red patch on the conjunctiva with sharply defined borders and normal conjunctiva surrounding it.
Episcleritis: sectoral area of subconjunctival injection (unilateral). The subconjunctival injection in episcleritis is superficial and, as a result, moveable with a swab (using topical anaesthesia) pressed gently on the conjunctiva.
Dry eye: caused by deficiencies in tear production and maintenance secondary to conditions such as blepharitis (obstruction of meibomian glands). Clinical features include diffuse conjunctival injection (unilateral or bilateral), inflamed lid margins with crusting and matted eyelashes.
List 5 painful causes of red eye
Painful red eye:
Scleritis: deep pinkish localised conjunctival injection (unilateral), visual acuity may be reduced, minimal watery discharge, photophobia and a tender globe (causing the patient to wake at night). Symptoms tend to progressively worsen and individuals commonly have other connective tissue diseases.
Uveitis: circumciliary conjunctival injection (unilateral), hazy cornea, distorted pupil, hypopyon, reduced visual acuity, watery discharge, photophobia and pain are common clinical features.
Corneal abrasion: eye redness, pain, watering and photophobia are common clinical features. Epithelial defects can be very hard to see with the naked eye but stain brightly with fluorescein drops and a cobalt blue light.
Corneal ulcer: typical clinical features include pain, watering, photophobia and a staining epithelial defect with associated haziness (infiltrates). The epithelial defect may appear fluffy, irregular and apparent even without a slit lamp.
Acute angle-closure glaucoma (AACG): typical clinical features include significant pain leading to vomiting, circumciliary conjunctival injection (unilateral), reduced visual acuity, photophobia, haloes in vision, hazy cornea and a mid-dilated unreactive pupil.
Foreign bodies: may be visible on the surface of the eye or embedded within the cornea or sclera. Associated clinical features include redness, pain, watering and a ‘foreign body sensation’. Foreign bodies may be hidden under the top and bottom of the eyelid.
What is the fundal reflex?
The term fundal reflex is preferred over red reflex as the colour of the healthy reflex varies depending on a patient’s skin colour.
In patient’s with lighter skin, the reflex typically appears orange-red in colour, whereas in those with darker skin, the reflex can be yellow-white or even blue in c
What is the following clincial sign and what are the underlying causes?
Causes of an absent fundal reflex
Absence of the fundal reflex in adults is often due to cataracts in the patient’s lens blocking the light. Other causes include vitreous haemorrhage and retinal detachment.
Absence of the fundal reflex in children can be due to congenital cataracts, retinal detachment, vitreous haemorrhage and retinoblastom
What is the following clinical sign and its underlying cause?
Contour: the borders of the optic disc should be clear and well defined. If the borders appear blurred it may suggest the presence of optic disc swelling (papilloedema) secondary to raised intracranial pressure.
What is the following clinical sign and its underlying cause?
Colour: a healthy optic disc should look like an orange-pink doughnut with a pale centre. The orange-pink colour represents well-perfused neuro-retinal tissue.
A pale optic disc suggests the presence of optic atrophy which can occur as a result of optic neuritis, advanced glaucoma and ischaemic vascular events.
What is an abnormal cup to disc ratio and what may it indicate?
Cup: the cup is the pale centre of the orange-pink doughnut mentioned previously. The pale colour of the cup is due to the absence of neuroretinal tissue.
The vertical size of the cup can be estimated in relation to the optic disc as a whole, known as the “cup-to-disc ratio”. A cup-to-disc ratio of 0.3 (i.e. the cup occupies one-third of the height of the optic disc) is generally considered normal. An increased cup-to-disc ratio suggests a reduced volume of healthy neuro-retinal tissue, which can occur in glaucoma.
What is the following clinical sign and its underlying cause?
Arteriolar narrowing: subtle, with generalised arteriolar narrowing with typical copper or silver wire appearance. Most commonly associated with the early stages of hypertensive retinopathy.
What is the following clinical sign and its underlying cause?
Arteriovenous nipping/nicking: areas of focal narrowing, and compression of venules at sites of arteriovenous crossing. The typical appearance involves bulging of retinal veins on either side of the area where the retinal artery is crossing. Most commonly associated with grade 2 hypertensive retinopathy.
What is the following clinical sign and its underlying cause?
Dot and blot haemorrhages: arise from bleeding capillaries in the middle layers of the retina and may look like microaneurysms if small enough. They are most commonly associated with diabetic retinopathy.
What is the following clinical sign and its underlying cause?
Flame haemorrhages: larger haemorrhages with a flame-like appearance caused by rupture of pre-capillary arterioles or small veins in the retinal nerve fibre layer. Most commonly associated with grade 3 hypertensive retinopathy, thrombocytopaenia, retinal vein occlusion and trauma.
What is the following clinical sign and its underlying cause?
Cotton wool spots: appear as small, fluffy, whitish superficial lesions and represent infarcts of the neuro-retinal layer. They are most commonly associated with diabetic retinopathy and grade 3 hypertensive retinopathy.
What is the following clinical sign and its underlying cause?
Hard exudates: waxy yellow lesions with relatively distinct margins arranged in clumps or rings, often surrounding leaking microaneurysms. They are most commonly associated with diabetic retinopathy and grade 3 hypertensive retinopathy.
What is the following clinical sign and its underlying cause?
Neovascularisation: formation of new blood vessels that appear as a net of small curly vessels, with or without associated haemorrhages. They may be located on the optic disc or elsewhere on the retina. They are most commonly associated with advanced proliferative diabetic retinopathy.
What is the following clinical sign and its underlying cause?
Pan-retinal photocoagulation: the primary treatment for proliferative diabetic retinopathy. Clinically it is seen as clusters of pale burn marks on the retina which have been created by the laser used in the treatment process.
What is the following clinical sign and its underlying cause?
Branch retinal vein occlusion: blockage of one of the four retinal veins, each of which drains about a quarter of the retina. Typical signs include flame haemorrhages, dot and blot haemorrhages, cotton wool spots, hard exudates, retinal oedema, and dilated tortuous veins.
What is the following clinical sign and its underlying cause?
Hard exudates: waxy yellow lesions with relatively distinct margins arranged in clumps or rings, often surrounding leaking microaneurysms. They are most commonly associated with diabetic retinopathy, grade 3 hypertensive retinopathy and retinal vein occlusions.
What is the following clinical sign and its underlying cause?
Drusen: yellow-white flecks scattered around the macular region representing remnants of dead retinal pigment epithelium. Most commonly caused by age-related macular degeneration.
What is the following clinical sign and its underlying cause?
Cherry-red spot: associated with central retinal artery occlusion which typically presents with sudden profound visual loss.
What is the following clinical sign and what is its underlying cause?
Peaked pupils in the context of trauma are suggestive of globe rupture (the peaked appearance is caused by the iris plugging the leak).
What is the following sign ?
ectropion
What is the following sign and what is the underlying cause?
diffuse haziness in acute angle-closure glaucoma
What is the following sign and what is the underlying cause?
Cornea: a patch of white infiltrate due to a corneal ulcer.
What is the following clinical sign and its underlying cause?
trichiasis (eye lashes rubbing on the cornea) and blepharitis collarettes
What is the following clinical sign and its underlying cause?
blepharitis collarettes
