Ophthalmology 101ver1

Fundal changes in common Fundal changes in common ophthalmologic conditionsophthalmologic conditionsA self-directed fundoscopy tutorial A self-directed fundoscopy tutorial for 4for 4thth year medical students year medical studentsEditorsEditors

Debby VugtsDebby VugtsLisette WijdemansLisette WijdemansAnselm Ong (MB ChB)Anselm Ong (MB ChB)

Design, Illustration & “eye-con” ArtworkDesign, Illustration & “eye-con” ArtworkAnselm Ong (MB ChB)Anselm Ong (MB ChB)

SupervisorSupervisorGordon SandersonGordon Sanderson

Normal fundus

Optic disc Optic cup

Macula

Superior temporal vein

Superior nasal vein

Inferior temporal vein

Inferior nasal vein

Superior temporal artery

Fovea

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What is the cup to disc ratio?

What does the arrow show?

notching of the neuroretinal rim

disc

cup (look at the bending point of the small vessels)

What is the cup to disc ratio?

0.5

What phenomenon does the arrow show?

Flasking (vessels disappear from view after turning into the cup)

These discs are from the same patient. How would you describe the discs?

They are asymmetrical

What is your provisional diagnosis?

Open-angle glaucoma

Peripapillary atrophy (as a result of aging)

Why is this a glaucomatous cup?

Vertical elongation of the cupISNT rule (thinning of the rim in the following order: inferior,

superior, nasal, temporal)

What does the arrow indicate?

Lamina Cribrosa

Bayonetting (quick angulation in the course of the blood vessels as they exit the nerve)

What do these arrows indicate?

Dilated vein

Describe what you seeWhat systemic disease are these signs

associated with?

Microaneurysm

Diabetes Mellitus

Hard exudates Hard

exudates

Blot haemorrhage

Flame haemorrhage

Describe these fundal abnormalities

Microaneurysm

What condition are these changes characteristic of?

Non proliferative diabetic retinopathy

Note: flame haemorrhages tend to be more common in hypertensive retinopathy

Hard exudates

Blot haemorrhage

Blot haemorrhage

Blot haemorrhage

Neovascularisation of the optic disc

Dot haemorrhage

MicroaneurysmFibrovascular

tissue secondary to longstanding neovascularisation

Describe the fundus

What is your diagnosis?

Proliferative diabetic retinopathy

What has happened here?

Pan Retinal Photocoagulation (PRP)PRP is used in the treatment of proliferative diabetic

retinopathy

Macular star

What are these arrows pointing at?

What condition is this feature associated with?

Hypertension

Cotton wool spot

Blot haemorrhage

Papilloedema

Hard exudates

AV crossing change

Flame haemorrhage

Describe the fundal abnormalities

What condition are these features characteristic of?

Preretinal haemorrhage

Severe hypertensive retinopathy

What is your diagnosis?

Branch Retinal Vein Occlusion (BRVO)

Which vein is affected? What is the characteristic feature of this condition?

Inferior temporal vein; lesion does not cross horizontal midline of the fundus

What is your diagnosis?

Central Retinal Vein Occlusion (CRVO)

Blood supply from the choroidal arteries (Cherry Red Spot)

Blood supply from cilioretinal artery

Note: Only 5% of the population will have a cilioretinal artery; therefore in most CRAOs only the Cherry Red Spot is seen

What has happened to this fundus?

Central Retinal Artery Occlusion (CRAO)

Why are there still areas of redness?

Blood supply from the cilioretinal artery and choroidal arteries are still intact

Describe the fundal changes

What is your diagnosis?

Hyperpigmentation and drusen of the macula

Dry Age Related Macular Degeneration (ARMD)

What is the name of this type of macular degeneration?

Disciform macular degeneration/ Wet ARMD

What types of lesion are these ?

What is the most likely cause of this lesion?

Chorioretinal scars

Toxoplasmosis

Old lesion

Active lesion

What is happening here?

Retinal detachment

What retinal pathology is present?

Retinitis pigmentosa

Is this a neavus or melanoma?

Is this a neavus or melanoma?

MelanomaMelanoma NaevusNaevusBigBig SizeSize SmallSmallMulticolouredMulticoloured ColourColour Single colourSingle colourIrregularIrregular EdgesEdges DistinctDistinctElevatedElevated ThicknessThickness FlatFlat

How can you differentiate between these two lesions?

What is your diagnosis?

Melanoma Naevus

What is wrong with this optic disc?

Papilloedema

#1 #2

Compare the 2 optic discs. Which is the healthy disc?

#2

What is the optic disc abnormality in #1?

Optic atrophy

The end