Ocular Fundus

Question 1

Fundus coloration is primarily due to pigment where?

Answer 1

Choroidal and RPE Pigment

Question 2

Yellow pigment can be due to :

Answer 2

Exudates or Drusen

Question 3

Exudates are found in what layer of the RPE? What must be compromised?

Answer 3

Found in Outer Plexiform Layer.

Caused by compromise by the outer BRB (tight junctions on apical side of RPE)

Question 4

The RPE can contribute to black color changes in the fundus by:

Answer 4

• Hypertrophy/Hyperplasia of RPE cells

- Response to inflammation of trauma

Question 5

What are the clinical findings of inflammation of RPE?

Answer 5

Taxoplasmosis, Photocoagulation spots, Retinitis pigmentosa

Question 6

Where can a pre-retinal hemorrhage be found?

Answer 6

Between the ILM and NFL

Question 7

Where does a pre-retinal hemorrhage come from?

Answer 7

The superficial (inner) capillary plexus of the Central Retinal Vasculature

Question 8

What shape is a pre-retinal hemorrhage? Why?

Answer 8

D-shaped

Gravity causes the blood to settle, darker blood at the bottom

Question 9

A preretinal hemorrage usually occurs where in the retina? What type of scotoma and how large in disc diameters?

Answer 9

Posterior Pole
Positive Scotoma
1-2 DD in size

Question 10

Flame shaped hemorrages have ____ edges. The blood follows the lines of ____ resistance in the NFL

Answer 10

feathered

least

Question 11

How long do flame shaped hemorrhages last?

Answer 11

4-8 weeks, very short

Question 12

Do flame shaped hemorrhages have an effect on vision? Where are they found? What does this represent?

Answer 12

• No effect on vision
• Found in posterior pole along contour of NFL
• Represents localized hypoxia (lack of oxygen)

Question 13

What systemic disease are flame shaped hemorrhages found mostly in?

Answer 13

Hypertension

Question 14

In what layers of the retina are blot and dot hemorrhages found?

Answer 14

Inner Nuclear Layer, Outer Plexiform Layer and Outer Nuclear Layer (extends vertically through layers)

Question 15

What are blot and dot hemes an indication of?

Answer 15

Deep retinal edema (deep retinal vascular stasis)

Question 16

Where does the blood come from in blot and dot hemes?

Answer 16

The deep (outer) capillary plexi of the central retinal vasculature (found in inner nuclear layer)

Question 17

Where are sub-retinal hemes mostly located?

Answer 17

Between RPE and sensory retina (i.e photoreceptors)

Question 18

What is the color of a fresh sub-retinal heme?

Answer 18

dark red

Question 19

What is the shape and location of subretinal hemes? Effect on vision?

Answer 19

Shape = lobulated
Location = posterior pole
Vision = scotomas

Question 20

Sub-RPE hemorrhages are what color?

Answer 20

gray-green color

Question 21

From what blood supply is a sub-retinal heme coming from?

Answer 21

Outer retinal blood supply = CHOROID!

Question 22

Most sub-retinal hemorrhages are _____ to choroidal neovascular membranes.

Answer 22

secondary