Fundoscopy picture quiz

Question 1

How to tell which eye you are looking at?

Answer 1

The optic forms a slightly raised spot on the nasal side of the retina.

Question 2

diagnose

Answer 2

Dry AMD with drusen

Drusen are the hallmark of dry AMD. These small yellow deposits beneath the retina are a buildup of waste materials.

Question 3

diagnose

Answer 3

central retinal artery occlusion

• Cherry red spot
• because amcular arterial supply from chrooid can remain in tact

Question 4

diagnose

Answer 4

central retina vein occlusion
Stormy sunset, pepporoni pizza
- papilloedema
- tortuosity and dilatation of all branches of the central retinal vein
- flame haemorrhages
- cotton wool spot

Question 5

diagnose

Answer 5

branch retinal vein occlusion

Question 6

diagnose

Answer 6

glaucoma
- optic disc cuppig due to high intraoccular pressure
- large cup to disc ratio >0.5 -> cupping

Question 7

diagnose

Answer 7

papilloedema

raised intracranial pressure or retinal vein occlusion
- disc margins ar eobscured and swollen and hyperaemic
- retinal vessels hsow toruostity

Question 8

features of retinal vein occlusion

Answer 8

a central retinal vein occlusion causes:

• papilledema
• retinal hemorrhages
• tortuous retinal veins
• painless loss of vision

Question 9

diagnose

Answer 9

normal fundus

The main clinical features are:

• Optic disc with uniform central cup with cup
  disc ratio <0.5 and normal
  neuroretinal rim
• Retinal vessels and macula look normal
• This degree of darker redness in the central
  macular area (fovea centralis) is normal
• The slight darkening of the peripheral retinal
  vessels is also normal

Question 10

diagnose

Answer 10

retinitis pigmentosa

Question 11

diagnose

Answer 11

wet age macula degeneration

Abnormal vessels grow into the subretinal space from the choroidal circulation. These vessels can leak and lead to subretinal hemorrhage, seen in figure 3, and subretinal fluid collections, indicating choroidal neovascularization. The goal is to recognize these new vessels before they bleed and cause a hemorrhagic detachment of the retinal pigment epithelium. Wet AMD is less common than dry AMD, affecting only 10 to 15 percent of people with AMD. However, it accounts for more than 80% of patients with severe visual loss or legal blindness

Question 12

Dry AMD vs Wet AMD

Answer 12

Features

• Amsler: distorted lines
• Fuzzy
• Difficult recognising faces
• Central scotoma

Question 13

diagnose

Answer 13

wet AMD

• bleeding in macula due to neovascularisation into the choroid

Question 14

diagnose

Answer 14

fundus after panretinal photocoagulation

to prevent severe vision loss and reduce the pain in the eye
- causes new blood vessels to shrink and dissapear -> no new bleeding or leakage
- The rationale behind the treatment is to reduce the production of VEGF by reducing the oxygen demand from the peripheral retina.
- Clinically it is seen as clusters of burn marks on the retina which have been created by the laser used in the treatment process.

Question 15

diagnose

Answer 15

retinal detachment

Question 16

diabetic retinopathy can be split into

Answer 16

• Background diabetic retinopathy
• Pre-proliferative diabetic retinopathy
• Proliferative diabetic retinopathy
• Advanced diabetic retinopathy

Question 17

Background diabetic retinopathy features

Answer 17

microaneurysm
dot and blot haemorrhages

Question 18

pre-proliferative diabetic retinopathy

Answer 18

• Cotton woold spots -> accumulation of dead nerve cells from ischaemic damage

Question 19

proliferative diabetic retinopathy

Answer 19

Neovascularisation

Question 20

Advanced diabetic retinopathy results in:

Answer 20

• Recurrent vitreous haemorrhage from bleeding areas of neovascularisation
• Tractional retinal detachments as areas of neovascularisation grow into the vitreous and form fibrous bands suspending the retina

Question 21

summary of diabetic retinopathy findings

Answer 21

Question 22

diagnose

Answer 22

diabetic retinopathy
- dot and blot haemorrhages
- cotton wool spots
- some evidence of neovascularisation

Question 23

keither wagner classification of Hypertensive retinopathy

Answer 23

Question 24

diagnose

Answer 24

stage 4 hypetensive retinopathy
- cotton wool spots
- retinal haemorrhage
- macula star
- hard exudates
- optic nerve head is swollen

Question 25

labelled hypertensive retinopathy

Answer 25

Question 26

diagnose

Answer 26

anterior uveitis * Dull, aching, painful red eye * Ciliary flush (a ring of red spreading from the cornea outwards) * Reduced visual acuity * Floaters and flashes * Sphincter muscle contraction causing miosis (constricted pupil) * Photophobia due to ciliary muscle spasm * Pain on movement * Excessive tear production (lacrimation) * Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes * A hypopyon is a collection of white blood cells in the anterior chamber, seen as a yellowish fluid collection settled in front of the lower iris, with a fluid level

Question 27

diagnose

Answer 27

* Typically not painful but there can be mild pain * Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera. * Foreign body sensation * Dilated episcleral vessels * Watering of eye * No discharge

Question 28

diagnose

Answer 28

Scleritis usually presents with an acute onset of symptoms. Around 50% of cases are bilateral. * Severe pain * Pain with eye movement * Photophobia * Eye watering * Reduced visual acuity * Abnormal pupil reaction to light * Tenderness to palpation of the eye

Question 29

diagnose

Answer 29

bacterial conjunctivitis

Question 30

diagnose

Answer 30

bacterial keratitis

Question 31

diagnose

Answer 31

herpatic keratitis - dendritic sign with fluoroscein

Question 32

diagnose

Answer 32

orbital cellulitis - opthalplegia - ophthalmalgia.

Question 33

diagnosis

Answer 33

p[thalmic shingles with ocular involement - hutchinson sign

Question 34

diagnosis

Answer 34

optic neuritis -> MS -> think RAPD

Question 35

diagnosis

Answer 35

Exophthalmos noted in axial view of CT-scan. Patient with TED also demonstrates enlargement of extra ocular muscles (asterisk). -> also loss of S shape of optic nerve

Question 36

diagnose

Answer 36

trochlear nerve palsy

Question 37

diagnose

Answer 37

oculomotor nerve palsy

Question 38

diagnose

Answer 38

abducens nerve palsy

Question 39

diagnose

Answer 39

Horners - miosis - anhydrosis - partial ptosis (superior tarsal)

Question 40

summary of nerve palsy

Answer 40