Fundoscopy Pictures

A selection of fundoscopic findings including diabetic retinopathy, retinal hemorrhage, retinal detachment, diabetic maculopathy, macular degeneration, glaucoma, papilloedema, giant cell arteritis, optic atrophy, retinal artery occlusion and retinal vein occlusion.

1. Fundoscopy revision

2. Normal fundus > Colour = pink > Clear contour > Normal cup > No haemorrhages/deposits etc > Retina in all positions

3. Diabetic Retinopathy - BACKGROUND Non proliferative, no neo-vascularisation Usually asymptomatic Occurs in almost everyone with DM in 8-10years Microaneurysms, retinal haemorrhages (dot/blot), exudates, cotton wool spots (nerve fibre degeneration), vascular calibre changes and intraretinal microvascular abnormalities.

4. Exudates are yellow areas where lipid has leaked from damaged vessels.

5. Proliferative DR Significant retinal ischaemia (more common in T1DM) triggers neo-vascularisation on the optic disc or retina. Small tufts of irregular vasculature Initially flat then progress and protrude into the vitreous

6. Retinal detachment Medical emergency as complete detachment causes blindness Usually after post vitreous detachment (flashes and floaters) or associated with DM.

7. Diabetic maculopathy DR with macula involvement - more common in T2DR Focal, diffuse, ischaemic - all referring to haemorrhages of microvasculature

8. Diabetic Retinopathy treatment Laser - focal or grid. Lasering the macula will blind the patient. Control diabetes and cardiovascular risk factors.

9. Macular Degeneration Age related (>50yo) Bilateral Progressive central scotoma Dry (atrophy) V. Wet (Neovasculature)

10. DRY MD Atrophy of the RPE and choroid Pigmentary changes Drusen - yellow/white accumulates that deposit between Bruch’s membrane and the RPE. Tends to be seen around the macula More common that wet MD, les debilitating

11. Wet MD 10% of MD but the severe type New blood vessels form under the retina and leak/bleed/scar OCCULT AMD is when the new vessels stay within Bruch’s membrane, CLASSIC AMD is when the vessels penetrate through Bruch’s membrane

12. Glaucoma Progressive optic neuropathy Peripheral visual field loss Ganglion cells of the optic nerve die causing cupping The cup thins ~0.8 and no longer follows the ISNT rule

13. Types of glaucoma? Primary open angle - associated with family history, age and myopia. Asymptomatic unto field defect. Primary acute angle closed - red eye, nausea/vomiting, acute pain Secondary

14. Papilloedema Bilateral swelling of the optic disc Due to increased intracranial pressure Blurring of the optic disc margins

15. Giant cell arteritis An immune mediated vasculitis Jaw claudication, scalp tenderness, headache, fever, bruis, possible blurred/double/lost vision Associated with polymyalgia rheumatica High dose steroids prevent blindness Causes optic atrophy (pale optic disc) and swelling of the optic disc. Also arterial occlusions

16. Optic atrophy Seen with Optic neuritis (recurrent indicates MS) Giant cell arteritis Foster kennedy (anosmia, central scotoma, optic atrophy and papilloedema due to frontal lobe tumour)

17. Central retinal artery occlusion Sudden painless LOV Typically due to emboli Cherry red spot

18. Central retinal vein occlusion May also be a branch occlusion Due to thrombosis/atherosclerosis Sudden painless LOV Flame hemorrhages