optic disc and temporal retina

Main clinical features:

Blot hemorrhages in the nasal macular area and superior temporal arcade
Hard exudates along the inferior temporal arcade
Micro aneurysms at the macula area
Circinate exudates along the inferior temporal arcade
Diagnosis: BACKGROUND DIABETIC RETINOPATHY AND DIABETIC MACULOPATHY
Comments
Macular area, as defined by a circle area centred on the fovea with its radius extending to the edge of the optic disc, has
exudates in it. This makes the condition maculopathy. If the visual acuity was normal and there are micro-aneurysms
and hemorrhage only, then this would be Background diabetic retinopathy alone.

MCF: optic disc and temporal retina (alignment marker is shown)

Multiple dot and blot hemorrhages
Cotton wool spots (CWS)
Intra-retinal micro-vascular abnormalities (IRMA)
Dx: PRE PROLIFERATIVE DIABETIC RETINOPATHY
Chikka:
Pre-proliferative diabetic retinopathy is characterized by retinal ischemia.
CWS represent areas of focal retinal ischemia and IRMA are a pathological attempt at micro-revascularization. IRMAs
are flat and do not grow into the vitreous.

Central fundus with the optic disc

MCF:
New vessels on the disc
Hemorrhages
Exudates
Pre0retinal fibrosis
DX: ADVANCED PROLIFERATIVE RETINOPATHY
Chikka:
On-going ischaemia and increase in vaso-proliferative factors. The new vessels grow into the vitreous and are fragile
leading to haemorrhage. A the hemorrhage organizes, fibrous tissue reaction occurs often resulting in retinal traction
and detachment

Optic disc and temporal retina

MCF
Multiple hard exudates in the macular area, some are circinate
Haemorrahges and micro-aneurysms
DX: DIABETIC MACULOPATHY
Chichi:
The visual acuity may be reduced depending on the location and macular edema.
Circinate hard exudates odten have micro-aneurysms at their center.
The darker retinal appearance is normal in an asian or afro-caribbean patient.

Optic disc and temporal retina (alignment marker is shown)

MCF:
Multiple laser scars with areas of hyper pigmentation
Regressed new vessels at the disc with residual gliosis
DX: PAN RETINAL LASER PHOTOCOAGULATION
Chismis:
The overall appearance suggests good response to management and stable retinopathy. Patient will have reduced
peripheral vision and a degree of night blindness (compare with retinitis pigmentosa)

Posterior pole centered on the optic disc

MCF:
Disc area is obscured
Poorly defined vasculature
DX UNGRADABLE RETINOPATHY
Chichi:
The suspicion of fibrovascular proliferation at the disc and along the vascular arcade with tractional detachment is very
strong. This would be a feature of advanced diabetic eye disease. Clearly, urgent referral is indicated.

Optic disc and temporal retina

MCF:
Optic disc with uniform central cup with cup disc ratio of <0.5 and pink neuroretinal rim
Retinal vessels and macula look normal. This degree of darker redness in the central macular area is normal
DX: NORMAL FUNDUS
Chismis:
Remember the classic sequence of looking at the retina:
Light reflex for cataract, arcus, xanthelasma, conjunctiva.
Start at the optic disc
Superior temporal arcade and inferior temporal arcade
Macular area
Superior nasal arcade and inferior nasal arcade
Peripheral, clockwise sweep to look for peripheral lesions

Posterior pole centered on the optic disc

MCF:
Large cup disc ratio
Superior polar notching
Nasal displacement of central blood vessels
DX: GLAUCOMATOUS OPTIC DISC
Cheezesm:
Glaucomatous damage and its extent is confirmed by visual fields and tomographic imaging techniques.

Optic disc and temporal retina

MCF:
Disc margins are obscured and swollen and hyperaemic
Retinal vessels show tortousity
DX PAPILLEDEMA
Insider info:
Spontaneous venous pulsation may be absent. If present, papilledema is unlikely. Visual symptoms are absent in early
stages. A space occupying lesion must be excluded urgently.

Optic disc and temporal retina sorry natapat sa no sim cameral roll hahaha
MCF:
Optic disc pallor with possible cupping
Large area of macular scarring
DX OPTIC ATROPHY with MACULAR SCARRING (AND POSSIBLE GLAUCOMA)
Chichi:
Age-related macular degeneration would be the commonest o diba commonest yun talaga nakalagay dun sa manual
cause of macular scarring

Optic disc and surrounding retina ito ata natapat sa butones

MCF
Disc margin and emerging vessels obscured by myelinated nerve fibers along superior and nasal areas
DX: MYELINATED NERVE FIBERS
Intel:
This requires no further clinical attention. On clinical examination, the blind spot would be expected to be larger, but
this would be very difficult to discern clinically.

Optic disc and temporal retina

MCF:
Focal areas of atrophy and retinal pigment
Drusens in the macular area
DX AGE RELATED MACULAR DEGENERATION
Chikka:
Presence of hemorrhages and edema in the macular area would suggest wet changes

Optic disc and temporal retina

MCF:
Multiple retinal hemorrhages
Venous dilation
DX MULTIPLE RETINAL HEMORRHAGES
Comment:
Hyperviscosity states (polycythemia, waldenstroms macro-globulinemia, myeloma) can lead to venous dilation and
hemorrhages. Thrombocytopenia and other bleeding diatheses are other possibilities

Posterior pole centered on the optic disc

MCF:
Large optic disc
Marked peripapillary chorioretinal atrophy
DX HIGH MYOPIA
Comments
Areas of chorioretinal atrophy in the macular area are not uncommon in highly myopic patients

Optic disc and temporal retina

MCF
Focal narrowing of arterioles
Changes at arterio-venous crossings along inferotemporal arcade (AV nipping)
DX: HYPERTENSIVE RETINOPATHY GRADE 2
Comment
Absence of hemorrhages (flame shaped) and disc swelling suggest early changes or chronic hypertension. The grading
system is:
Micro aneurysms are rare in hypertensive retinopathy without DM
Grade 1: arteriolar narrowing
Grade 2: arteior venous nipping
Grade 3: exudates, hemorrhages, cotton wool spots
Grade 4: papilledema

Optic disc and temporal retina

MCF
Pigmented clumps in the macular area with chorio-retinal atrophy and scarring. Pallor of the optic disc is noted
indicating atrophy
DX MACULAR SCAR (TOXOPLASMOSIS)
Comments
The cat is definitive host for toxoplasma gondii. This is usually a quiescent lesion often discovered incidentally when a
child is assessed for impair vision. An active lesion may show an inflammatory focus with a vitreous haze and adjacent to
a previous scar and vasculitis. There may be associated anterior uveitis.

Temporal retina
MCF
Areas of bullous retina showing elevation with fluid
DX RETINAL DETACHMENT
Comment:
In the absence of identifiable break and trauma, the possibility of choroidal metastasis should be considered. Clearly
urgent referral is needed.

Peripheral retina
MCF
Green grey flat asymptomatic lesion with detactable but not sharp borders
Presence of surface drusens
Areas of atrophy within the lesion
DX CHOROIDAL NEVUS
Comment
In view of the larger size >5mm, it is worth monitoring for a period. If there is a change in size, further investigation is
indicated.

Optic disc and temporal retina

MCF
Dense white areas along vessels with vasculitis along temporal arcade.
DX: CYTOMEGALOVIRUS RETINITIS
Comment:
The spread of vasculitis can be relentless from periphery to the disc along retinal vessels. Hemorrhages may be present
in fulminating cases.

Optic disc and tempura retina

MCF:
Papilledema
Tortousity and dilation of all branches of the central retinal vein
Retinal hemorrhages: flame shaped, dot and blot in all quadrants
Cotton wool spots
DX CENTRAL RETINAL VEIN OCCLUSION
Comment:
The presence of CWS would suggest significant ischemic element carrying poor prognosis. Space occupying lesions in the
cerebrum and hyperviscosity have to be excluded. Hypertension alone can cause CRVO

Temporal retina and optic disc

MCF:
Attenuation of arteries and veins
Pale temporal edge of the optic disc is shown
Central cherry red spot with surrounding pale retina
DX CENTRAL RETINAL ARTERY OCCLUSION
Comments:
Poor prognosis due to retinal infarction. Retinal cloudiness of pale retina would disappear after a few weeks. Attenuated
vessels would remain and consecutive optic atrophy would be evident. The cherry red spot is seen because of macular
arterial supply from the choroid can remain intact. Often there is a band of neural tissue that is not rendered ischemic
by the CRAO, this is seen if there is an adequate cilio-retinal artery supply

Optic disc and surrounding retina

MCF
Yellow Orange refractile bodies at an arterial bifurcation (12 oclock on the optic disc) asan di ko Makita.ahahahha
DX RETINAL ARTERY CHOLESTEROL EMBOLI (HOLLENHORST PLAQUE)
Comments
Frequently asymptomatic as it rarely causes significant obstruction of the arteriole unike calcific emboli. Fibrinoplatelet
emboli cause transient retinal ischemic attacks (amaurosis fugax) which may occasionally be complete.

Mid peripheral retina

MCF
Multiple bony spicule retinal pigmentation scattered in the periphery of the retina
DX RETINITIS PIGMENTOSA
Comments
The associated history of night blindness and family history is often positive.
The optic disc may show waxy pallor with attenuation of vessels.

Optic disc and surrounding retina

MCF
Linear reddish brown lesions with irregular edges beneath the normal retinal vessels. This represents breaks in Bruchs
membrane and visualization of the choroidal circulation
Peripheral focal chorio retinal scars may be present
DX ANGIOID STREAKS
Comments
Bruchs membrane is mainly elastin. The condition is associated with connective tissue disorders. This includes:
pseudoxanthoma elasticum, Ehler-Danlos syndrome, Marfans. Rarely: Pagets disease, acromegaly, and certain
hemoglobinopathies

Peripheral retina
MCF
Elevated dome shaped grey mass
DX MALIGNANT MELANOMA
A secondary retinal detachment may be present. Urgent referral indicated

Optic disc surrounding retina

MCF
Flat pigmented lesion involving inferior aspect of the optic disc
DX BENIGN DISC NEVUS
Often difficult to distinguish from malignancy. If in douct seek a specialist opinion

Optic disc and temporal retina

MCF
Large macular hemorrhage in the pre retinal area
DX MACULAR HEMORRHAGE
Sudden severe intrathoracic or abdominal pressure and lead to this feature. Macular degeneration and diabetic
retinopathy can be considered in the presence of additional features. A pre retinal hemorrhage with a fluid levelcan be
seen in some patients with sub-arachnoid hemorrhage. Small areas of hemorrhages adjacent of blood vessel are seen in
bacterial endocarditis (Roths spot)

Optic disc and temporal retina

MCF
Pale yellow appearance of vessels in a creamy retinal background
DX LIPAEMIA RETINALIS
This is associated with hypertriglyceridemia and hypercholesterolemia. This is usually encountered in lipid disorders,
poorly controlled diabetes and alcoholism