Fundoscopy spot diagnosis Flashcards
Quadrants of the retina (right eye)
Quadrants of retina (right eye)
Spot diagnosis + stage of diabetic retinopathy
Microaneurysms
- Background diabetic retinopathy
Spot diagnosis + stage of diabetic retinopathy
Dot and blot haemorrhages - arise from bleeding capillaries in middle layers of retina
- Background diabetic retinopathy
Spot diagnosis + stage of diabetic retinopathy
Cotton wool spots - dead nerve cells from ischaemic damage
- Pre-proliferative diabetic retinopathy
Spot diagnosis + stage of diabetic retinopathy
NVD and NVE - insufficient retinal perfusion results in production of VEGF (which results in neovascularization)
- Proliferative diabetic retinopathy
primary treatment for proliferative diabetic retinopathy
- reduces VEGF production by reducing oxygen demand from peripheral retina
Spot diagnosis + type of diabetic retinopathy + management
Hard exudates over macula - microaneurysms leak plasma which precipitate in lipid-rich protein deposits
- Diabetic maculopathy
- management –> anti-VEGF injections, laser treatment, dexamethasone implants
compression of venules at sites of arteriovenous crossing
Spot diagnosis + condition this is seen in
Geographic atrophy
- seen in late-stage form of AMD
Spot diagnosis + condition this is seen in
- extensive haemorrhages + cotton wool spots + optic disc swelling (papilloedema) + ring of exudates around macula (macular star)
- Malignant hypertension
Spot diagnosis + condition this is seen in
“Cupping” - increased vertical cup-to-disc ratio
- Glaucoma
Spot diagnosis + causes of this pathology
Epiretinal membranes - scar tissue on macula
- Causes: aging, trauma/inflammation, diabetes
Spot diagnosis + management
Papilloedema - optic disc swelling secondary to raised ICP
Management: Reduce ICP –> Acetazolamide
Spot diagnosis
Optic nerve atrophy - death of nerve fibres within optic nerve
Spot diagnosis + condition this is seen in + management
“cherry-red spot” - occurs due to the intact reflex of the fovea standing out against a pale ischaemic retina
- Central retinal artery occlusion (CRAO)
- Management (EMERGENCY) –> ocular massage, IOP-lowering (surgery/paracentesis, timolol/other IOP-lowering drops)
Spot diagnosis + management
‘stormy sunset’ - haemorrhages, cotton wool spots, tortuous veins, disc swelling
- Central retinal vein occlusion (CRVO)
- Management –> anti-VEGF injections
Spot diagnosis + condition this is seen in
Drusen deposits
- dry AMD (note: dry AMD produces no exudation or neovascularisation)
Spot diagnosis
Normal fundus
- Optic disc (3 C’s) - normal colour, uniform central cup (ratio < 0.5) with a normal neuroretinal rim
- Inspect all 4 quadrants of retina - no pathology
- Macula/Fovea - no pathology
- Blood vessels - retinal veins/arteries normal
Spot diagnosis
Multiple retinal haemorrhages
Spot diagnosis + Causes + Management
Pre-retinal haemorrhage - boat-shaped
- Causes: proliferative diabetic retinopathy, trauma, SAH
- Management –> slef-limiting (observation), avoid anticoagulants and strenuous activities, +/- laser surgery and vitrectomy
Spot diagnosis
Glaucoma - increased cup-to-disc ratio (> 0.5), due to raised IOP
Spot diagnosis + management
Retinal detachment - bulbous retina with elevation due to fluid
- management –> Vitrectomy
Spot diagnosis + management
Branch retinal vein occlusion - tortuosity of veins + AV nipping with microaneurysms
- management –> anti-VEGF injections, steroids, laser?
Spot diagnosis + type of poor vision associated
Retinitis pigmentosa - bony spicule pattern + retinal pigmentation (scattered in periphery of retina)
- genetic disease and may be associated hx of poor night vision (primarily affects rods)
Spot diagnosis + Management
Glaucoma - increased cup disc ratio
Management:
1. Prostaglandin analogues –> latanoprost
2. Beta-blockers –> timolol
3. Surgery –> laser trabeculoplasty
(If AACG –> IV acetazolamide + IOP-lowering drops + laser peripheral iridotomy)
Spot diagnosis + conditions this finding is associated with
Flame haemorrhages - larger haemorrhages with flame-like appearance
- associated with retinal artery/vein occlusion (RAVO), hypertensive retinopathy, and trauma
Spot diagnosis + condition seen in + treatment
Neovascularisation - formation of new blood vessels that appear curly (NVD / NVE)
- seen in proliferative diabetic retinopathy
- Treatment –> anti-VEGF injections and/or panretinal laser photocoagulation
Aetiology of CRAO and CRVO
- CRAO: usually carotid stenosis / emboli (eg. stroke) blocking central retinal artery/ophthalmic artery/carotid artery OR sometimes vasculitis (GCA)
- CRVO: occurs secondary to atherosclerotic thickening of the central retinal artery compressing the central retinal vein at a crossing point
Primary and secondary causes of optic nerve atrophy
- Primary: inflammation (optic neuritis), glaucoma or general retinal ischaemia
- Secondary: longstanding papilloedema
Causes of optic disc swelling (3)
- Raised ICP (papilloedema)
- Inflammation (optic neuritis)
- IIH
Grading of hypertensive retinopathy (4 grades)
- Grade 1: subtle changes (generalised arteriolar narrowing)
- Grade 2: areas of focal narrowing + AV nipping
- Grade 3: features similar to pre-proliferative diabetic retinopathy (retinal haemorrhages, hard exudates and cotton wool spots)
- Grade 4: Malignant hypertension (previous features + optic disc swelling)
Stages of diabetic retinopathy (4 stages)
Label the retinal quadrants
(top image shows a left eye)
Macula pathology - name 3 findings
- Hard exudates - yellow lesions associated with diabetic retinopathy, hypertensive retinopathy, and vein occlusions
- Drusen - yellow flecks caused by AMD
- Cherry red spot - central retinal artery occlusion
What is used to dilate the pupil in a fundoscopy exam + how does it work?
Tropicamide 1% - short-acting mydriatic drops
(relaxes the pupillary sphincter muscle)
Spot diagnosis + conditions seen in
Macula star - ring of exudate on macula
- severe hypertensive retinopathy
- papilloedema
- ischaemic optic neuropathy
Spot diagnosis
Retinal detachment
