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Retinal Conditions

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Retinal Conditions

  1. 1. Ophthalmology 101ver1 Fundal changes in commonFundal changes in common ophthalmologic conditionsophthalmologic conditions A self-directed fundoscopy tutorial for 4A self-directed fundoscopy tutorial for 4thth year medical studentsyear medical students EditorsEditors Debby VugtsDebby Vugts Lisette WijdemansLisette Wijdemans Anselm Ong (MB ChB)Anselm Ong (MB ChB) Design, Illustration & “eye-con” ArtworkDesign, Illustration & “eye-con” Artwork Anselm Ong (MB ChB)Anselm Ong (MB ChB) SupervisorSupervisor Gordon SandersonGordon Sanderson
  2. 2. Normal fundus Optic disc Optic cup Macula Superior temporal vein Superior nasal vein Inferior temporal vein Inferior nasal vein Superior temporal artery Fovea
  3. 3. CHOOSE A SLIDE #1
  4. 4. CHOOSE A SLIDE #2
  5. 5. CHOOSE A SLIDE #3
  6. 6. CHOOSE A SLIDE #4
  7. 7. CHOOSE A SLIDE #5
  8. 8. CHOOSE A SLIDE #6
  9. 9. 0.7 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)
  10. 10. 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)
  11. 11. These discs are from the same patient. How would you describe the discs? They are asymmetrical What is your provisional diagnosis? Open-angle glaucoma
  12. 12. Peripapillary atrophy (as a result of aging) Why is this a glaucomatous cup? Vertical elongation of the cup ISNT rule (thinning of the rim in the following order: inferior, superior, nasal, temporal) What does the arrow indicate?
  13. 13. Lamina Cribrosa Bayonetting (quick angulation in the course of the blood vessels as they exit the nerve) What do these arrows indicate?
  14. 14. Dilated vein Describe what you see What systemic disease are these signs associated with? Microaneurys m Diabetes Mellitus
  15. 15. 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
  16. 16. Hard exudates Blot haemorrhage Blot haemorrhage Blot haemorrhage Neovascularisation of the optic disc Dot haemorrhage Microaneurysm Fibrovascular tissue secondary to longstanding neovascularisation Describe the fundus What is your diagnosis? Proliferative diabetic retinopathy
  17. 17. What has happened here? Pan Retinal Photocoagulation (PRP) PRP is used in the treatment of proliferative diabetic retinopathy
  18. 18. Macular star What are these arrows pointing at? What condition is this feature associated with? Hypertensio n
  19. 19. Cotton wool spot Blot haemorrhage Papilloedema Hard exudates AV crossing change Flame haemorrhageDescribe the fundal abnormalities What condition are these features characteristic of? Preretinal haemorrhage Severe hypertensive retinopathy
  20. 20. 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
  21. 21. What is your diagnosis? Central Retinal Vein Occlusion (CRVO)
  22. 22. 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
  23. 23. Describe the fundal changes What is your diagnosis? Hyperpigmentation and drusen of the macula Dry Age Related Macular Degeneration (ARMD)
  24. 24. What is the name of this type of macular degeneration? Disciform macular degeneration/ Wet ARMD
  25. 25. What types of lesion are these ? What is the most likely cause of this lesion? Chorioretinal scars Toxoplasmosis Old lesion Active lesion
  26. 26. What is happening here? Retinal detachment
  27. 27. What retinal pathology is present? Retinitis pigmentosa
  28. 28. Is this a neavus or melanoma?
  29. 29. Is this a neavus or melanoma?
  30. 30. MelanomaMelanoma NaevusNaevus BigBig SizeSize SmallSmall MulticolouredMulticoloured ColourColour Single colourSingle colour IrregularIrregular EdgesEdges DistinctDistinct ElevatedElevated ThicknessThickness FlatFlat How can you differentiate between these two lesions?
  31. 31. What is your diagnosis? Melanoma Naevus
  32. 32. What is wrong with this optic disc? Papilloedema
  33. 33. #1 #2 Compare the 2 optic discs. Which is the healthy disc? #2 What is the optic disc abnormality in #1? Optic atrophy
  34. 34. The end

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