1. An Introduction to Examination of the EYE CSP 06.02.01

2. Components Inspection Visual acuity Visual fields Extraocular muscles Pupillary rxns Ophthalmoscopy Special tests

3. Normal Fundus IDENTIFY –optic disc –vascular arcades –macula (fine & colour vision, reading & depth perception)

4. Fundal Abnormalities atrophy of the retina pigmentation abnormalities deposits optic nerve abnormalities glaucoma optic atrophy retinal vessel abnormalities

5. The Retina The RETINA is an extension of the CNS & is a transparent multi-layered organ derived from the embryonic optic disc cup. RPE - retinal pigment epithelium Neuroretina

6. Retina reflection of systemic disease hard exudates - yellow/white deposits - arranged in rings - leakage of lipoproteins - diabetes, ht, retinal v. occlusion soft exudates - ‘cotton’ wool deposits - around infarcted areas - swelling of nerve fibre layer axons - may be assoc. with other features of retinal ischaemia DEPOSITS

7. Retina reflection of systemic disease Haemorrhages (NB diabetes & ht) superficial retinal:flame shaped deep:dark-red blots micro-aneurysms:similar to deep but smaller - dots preretinal:retina obscured, flat-topped fluid level vitreous:fundus hazy, abnormal red reflex choroidal:very dark red, large, wavy margins Retinal artery occlusion, retinal vein occlusion, ischaemic optic neuropathy VESSEL ABNORMALITIES

8. Hypertensive Retinopathy Vessel walls thicken in chronic hypertension and lead to diffuse/segmental narrowing of the arteriolar blood column. Iarteriolar narrowing / silver wiring IIA-V nipping IIIflame-shape haemorrhages hard exudates cotton wool spots IVpapilloedema (swollen disc) = malignant hypertension

9. Gd III Ht RETINOPATHY

10. Gd IV Ht RETINOPATHY

11. COTTON WOOL SPOTS

12. Diabetic Retinopathy Background Pre-proliferative Proliferative Microangiopathy of DM affects the retinal capillaries resulting in widespread capillary non-perfusion.

13. BACKGROUND

15. PRE-PROLIFERATIVE Multiple cotton wool spots in preproliferative diabetic retinopathy Vascular loop in preproliferative diabetic retinopathy

16. PROLIFERATIVE