Fundoscopy picture quiz Flashcards
How to tell which eye you are looking at?
The optic forms a slightly raised spot on the nasal side of the retina.
diagnose
Dry AMD with drusen
Drusen are the hallmark of dry AMD. These small yellow deposits beneath the retina are a buildup of waste materials.
diagnose
central retinal artery occlusion
- Cherry red spot
- because amcular arterial supply from chrooid can remain in tact
diagnose
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
diagnose
branch retinal vein occlusion
diagnose
glaucoma
- optic disc cuppig due to high intraoccular pressure
- large cup to disc ratio >0.5 -> cupping
diagnose
papilloedema
raised intracranial pressure or retinal vein occlusion
- disc margins ar eobscured and swollen and hyperaemic
- retinal vessels hsow toruostity
features of retinal vein occlusion
a central retinal vein occlusion causes:
- papilledema
- retinal hemorrhages
- tortuous retinal veins
- painless loss of vision
diagnose
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
diagnose
retinitis pigmentosa
diagnose
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
Dry AMD vs Wet AMD
Features
- Amsler: distorted lines
- Fuzzy
- Difficult recognising faces
- Central scotoma
diagnose
wet AMD
- bleeding in macula due to neovascularisation into the choroid
diagnose
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.
diagnose
retinal detachment
diabetic retinopathy can be split into
- Background diabetic retinopathy
- Pre-proliferative diabetic retinopathy
- Proliferative diabetic retinopathy
- Advanced diabetic retinopathy
Background diabetic retinopathy features
microaneurysm
dot and blot haemorrhages
pre-proliferative diabetic retinopathy
- Cotton woold spots -> accumulation of dead nerve cells from ischaemic damage
proliferative diabetic retinopathy
Neovascularisation
Advanced diabetic retinopathy results in:
- 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
summary of diabetic retinopathy findings
diagnose
diabetic retinopathy
- dot and blot haemorrhages
- cotton wool spots
- some evidence of neovascularisation
keither wagner classification of Hypertensive retinopathy
diagnose
stage 4 hypetensive retinopathy
- cotton wool spots
- retinal haemorrhage
- macula star
- hard exudates
- optic nerve head is swollen
labelled hypertensive retinopathy
diagnose
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
diagnose
- 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
diagnose
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
diagnose
bacterial conjunctivitis
diagnose
bacterial keratitis
diagnose
herpatic keratitis
- dendritic sign with fluoroscein
diagnose
orbital cellulitis
- opthalplegia
- ophthalmalgia.
diagnosis
p[thalmic shingles with ocular involement - hutchinson sign
diagnosis
optic neuritis -> MS
-> think RAPD
diagnosis
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
diagnose
trochlear nerve palsy
diagnose
oculomotor nerve palsy
diagnose
abducens nerve palsy
diagnose
Horners
- miosis
- anhydrosis
- partial ptosis (superior tarsal)
summary of nerve palsy
