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Fundoscopy

The normal fundus

The optic disc is oval in shape and yellow. There is a central, lighter coloured area. Sometimes, a darker crescent shaped feature is present around the medial portion of the disc. Veins are darker and larger. Both arteries and veins pass superiorly and inferiorly. A single artery supplies the macula area (left) and the fovea centralis.

Papilloedema

The optic disc is swollen, due to raised inter- cranial pressure. The disc will become reddened and there will be loss of definition of its margins. The veins may become distented if onset is rapid (e.g. sub-dural Haematoma). Distortion of all vessels may occur in advanced disc swelling. The oedema of the disc may extend across the retina resulting in off-white striations.
Visual disturbance is rare, but may produce transient scotomata in severe cases

Pseudopapilloedema

This is a very rare congential malformation of the disc. All vessels are normal, but the shape of the disc is blurred and reddened. This condition is associated with hypermetropia but is otherwise without consequence.

Papilloedema can occur in:-
All brain tumours (but rare in Pituitary) .
Brain abcesses .
Dural / arachnoid Haematomas
Malignant / benign intercranial Hypertension
Chronic Meningitis (not in acute)

Emboli and Occlusion

Retinal Emboli


Atheromatous plaques and cholesterol emboli can occlude the retinal arteries leading to yellowed thready appearance swollen. the arteries can be narrowed or thread- like. The fundus will be paler than usual, this is sometimes accompanied by a redder Macula.

Central Retinal Vein Occlusion

 

Haemorrhages and distended, distorted veins are present. The optic disc is also swollen. This can occur in all types of Phlebitis, thrombosis and some Leukaemias.

Diabetes

Round shaped Haemorrhages are present. Smaller dot-like microaneurysms occur in the macula area. Bead-like waxy exudates may also occur. New vessel formation is a charactristic feature in severe, long standing diabetes, leading to loss of vision in the pathology, affected areas.

Hypertension

Arteries can be narrowed or irregular. Aterio-venous nipping can occur where the arteries cause venous occlusion. "Flame shape" haemorrhages and "cotton wool" exudates are present. (Unusually for these are not named after food) "Silver Wiring" is another feature of the smaller arteries, due to pressure changes.

hometopmap

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