Retinopathy

Question 1

how is diabetic retinopathy classified?

Answer 1

R1: Mild Non Proliferative

R2: Moderate Non Proliferative

R2: Severe Non Proliferative

R3: Proliferative New Vessels (Disc) NVD

R3: Proliferative New Vessels (Elsewhere) NVE

M1: Diabetic Maculopathy/ Macular Oedema

Question 2

What are dot and blot haemorrhages?

Answer 2

red dots - retinal micro aneurysms

blot - mid retinal haemorrhages

Question 3

What are hard exudate on retina?

Answer 3

Hard Exudates are deposits of lipids and proteins that leak out
and accumulate from capillaries

Question 4

What are cotton wool spots?

Answer 4

Cotton Wool Spots – Occlusion of retinal pre-capillary arterioles
supplying the nerve fibre layer, causing swelling of nerve fibre
layers

Question 5

What is IRMA on the retina?

Answer 5

Intraretinal microvascular

abnormalities

Question 6

On diabetic eye examination you see dot and blot haemorrhages. What is the treatment?

Answer 6

Treatment:

• Improve Systemic Control
• Observe in screening

Question 7

On diabetic eye examination you see: 
1. Microaneurysms / multiple
haemorrhages
2. Exudates
3. Cotton Wool Spots

What is the treatment?

Answer 7

Treatment:

• Improve Systemic Control
• Refer to clinic and observe

Question 8

On diabetic eye examination you see: 
1. Extensive haemorrhages
2. Venous beading
3. Intraretinal microvascular
abnormalities (IRMA)

What is the treatment?

Answer 8

• Watch for new vessels
• Treat any maculopathy
• Follow up 3-4 monthly
• Improve Systemic Control

Question 9

On diabetic eye examination you see:
Fine new vessels at disc (NVD) or elsewhere (NVE) +/- vitreous
haemorrhage

What is the treatment?

Answer 9

Urgent pan-retinal Laser

Photocoagulation

Question 10

On diabetic eye examination you see:
Fibrosis, vitreous haemorrhage,
Retinal detachment

What is the treatment?

Answer 10

Vitreoretinal surgery

Question 11

Symptoms of Accelerated hypertension

Answer 11

Asymptomatic, occipital headaches, blurred vision, transient

obscurations

Question 12

Signs of Accelerated hypertension

Answer 12

Cotton wool spots, haemorrhages, optic disc swelling, hypertensive
encephalopathy

Question 13

Management of Accelerated hypertension

Answer 13

• Urgent admission
• In severe cases intravenous sodium nitroprusside
• In milder cases oral nifedipine or atenolol
• Look for secondary causes of hypertension eg renal artery stenosis,
phaeochromocytoma

Question 14

Features of retinal vein occlusion

Answer 14

“stormy sunset”, widespread haemorrhage without other features, may be branch vein occlusion

Question 15

Features of retinal artery occlusion

Answer 15

retinal pallor, cherry red spot, may even see cholesterol embolus

Markedly reduced vision, relative afferent pupillary defect,
whitening of the retina with cherry red spot, segmentation of
retinal vessels, embolus

Question 16

What is a “cherry red spot”

Answer 16

sign of retinal artery occlusion

Question 17

Causes of Central retinal artery occlusion

Answer 17

Atheroma, embolus (carotid artery or cardiac), arteritis, raised intraocular pressure

Question 18

Symptoms of Central retinal artery occlusion

Answer 18

Preceding amaurosis, sudden, painless loss of vision or field defect

Question 19

signs of Central retinal artery occlusion

Answer 19

Markedly reduced vision, relative afferent pupillary defect,
whitening of the retina with cherry red spot, segmentation of
retinal vessels, embolus

Question 20

Management of Central retinal artery occlusion

Answer 20

• If within 8 hours, iv acetazolamide, ocular massage, anterior chamber paracentesis, re-breathing into a paper bag. If more than 8 hours, no immediate treatment
• ESR, CRP, (FBC)
• Aspirin

Question 21

What is Papilloedema?

Answer 21

Bilateral Optic Disc
Swelling due to raised
intracranial pressure
• MUST EXCLUDE A
SPACE OCCUPYING
LESION 
• Idiopathic intracranial
hypertension