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

4. 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.

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

11. 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

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

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

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

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

19. 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

21. 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

23. 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

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

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

28. 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

30. 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)

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

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