2. Only place in the body where blood vessels can
be visualized directly
Mirror the status of the systemic circulation
Continuity of nerve fibers and meninges
Reflects specific changes in systemic diseases
Contribute to diagnosis
3. Direct ophthalmoscopy
Indirect opthalmoscopy
Sterioscopical view possible
4. Ideally fundus should be examined
in a darkened room
Patient should be asked to fix their gaze on a
distant object
Examine with corresponding eyes
The ideal line of approach should bring the
optic disc straight in to view
If only blood vessels on a pink background are
seen they should be followed , the disk will
eventually come in to view
6. Uniform red to pink
Disc-pale pink
1.5 mm in diameter
Nasal margin slightly blurred
Vessels emanate from optic cup
Consist of central cup and
peripheral neuroretinal rim
Macula temporally
Fovea 2.5mm-diameter, darker
7. Uniform red to pink
Disc-pale pink
1.5 mm in diameter
Nasal margin slightly blurred
Vessels emanate from optic cup
Consist of central cup and
peripheral neuroretinal rim
Macula temporally
Fovea 2.5mm-diameter, darker
8. Uniform red to pink
Disc-pale pink
1.5 mm in diameter
Nasal margin slightly blurred
Vessels emanate from optic cup
Consist of central cup and
peripheral neuroretinal rim
Macula temporally
Fovea 2.5mm-diameter, darker
9. Uniform red to pink
Disc-pale pink
1.5 mm in diameter
Nasal margin slightly blurred
Vessels emanate from optic cup
Consist of central cup and
peripheral neuroretinal rim
Macula temporally
Fovea 2.5mm-diameter, darker
10. Uniform red to pink
Disc-pale pink
1.5 mm in diameter
Nasal margin slightly blurred
Vessels emanate from optic cup
Consist of central cup and
peripheral neuroretinal rim
Macula temporally
Fovea 2.5mm-diameter, darker
11. Uniform red to pink
Disc-pale pink
1.5 mm in diameter
Nasal margin slightly blurred
Vessels emanate from optic cup
Consist of central cup and
peripheral neuroretinal rim
Macula temporally
Fovea 2.5mm-diameter, darker
12. Uniform red to pink
Disc-pale pink
1.5 mm in diameter
Nasal margin slightly blurred
Vessels emanate from optic cup
Consist of central cup and
peripheral neuroretinal rim
Macula temporally
Fovea 2.5mm-diameter, darker
13. Uniform red to pink
Disc-pale pink
1.5 mm in diameter
Nasal margin slightly blurred
Vessels emanate from optic cup
Consist of central cup and
peripheral neuroretinal rim
Macula temporally
Fovea 2.5mm-diameter, darker
14. Tygroid fundus
Deeply pigmented choroid
Choroidal vessels are seen
Polygonal pigmented areas
in between
15.
16. Dot haemorrhages
Deep within the retina
Leakage of capillaries, venules
Common in diabetes
Flame haemorrhages
Superficial nerve fibre layer
Leakage of capillaries, venules
that are ischemic or, in the case of
veins, under high pressure
Boat haemorrhages (pre-retinal)
Interface between retina & vitreous
Sub macular h‟ge, Preretinal h‟ge, Retinal h‟ge
17. Dot haemorrhages
Deep within the retina
Leakage of capillaries, venules
Common in diabetes
Flame haemorrhages
Superficial nerve fibre layer
Leakage of capillaries, venules
that are ischemic or, in the case of
veins, under high pressure
Boat haemorrhages (pre-retinal)
Interface between retina & vitreous
Sub macular h‟ge, Preretinal h‟ge, Retinal h‟ge
18. Dot haemorrhages
Deep within the retina
Leakage of capillaries, venules
Common in diabetes
Flame haemorrhages
Superficial nerve fibre layer
Leakage of capillaries, venules
that are ischemic or, in the case of
veins, under high pressure
Boat haemorrhages (pre-retinal)
Interface between retina & vitreous
Sub macular h‟ge, Preretinal h‟ge, Retinal h‟ge
19. Dot haemorrhages
Deep within the retina
Leakage of capillaries, venules
Common in diabetes
Flame haemorrhages
Superficial nerve fibre layer
Leakage of capillaries, venules
that are ischemic or, in the case of
veins, under high pressure
Boat haemorrhages (pre-retinal)
Interface between retina & vitreous
Sub macular h‟ge, Preretinal h‟ge, Retinal h‟ge
20. Dot haemorrhages
Deep within the retina
Leakage of capillaries, venules
Common in diabetes
Flame haemorrhages
Superficial nerve fibre layer
Leakage of capillaries, venules
that are ischemic or, in the case of
veins, under high pressure
Boat haemorrhages (pre-retinal)
Interface between retina & vitreous
Sub macular h‟ge, Preretinal h‟ge, Retinal h‟ge
21. Dot haemorrhages
Deep within the retina
Leakage of capillaries, venules
Common in diabetes
Flame haemorrhages
Superficial nerve fibre layer
Leakage of capillaries, venules
that are ischemic or, in the case of
veins, under high pressure
Boat haemorrhages (pre-retinal)
Interface between retina & vitreous
Sub macular h‟ge, Preretinal h‟ge, Retinal h‟ge
22. Hard exudate
Deep yellow with sharp margins
Often circinate
Leakage from pre-capillary arterioles
DM, HTN, VHL disease, radiation
„Macular star‟
Soft exudate(cotton wool spot)
Fluffygray-white, near optic disc
Retinal nerve fiber layer microinfarction
HTN, DM, connective tissue disease,HIV
23. Hard exudate
Deep yellow with sharp margins
Often circinate
Leakage from pre-capillary arterioles
DM, HTN, VHL disease, radiation
„Macular star‟
Soft exudate(cotton wool spot)
Fluffygray-white, near optic disc
Retinal nerve fiber layer microinfarction
HTN, DM, connective tissue disease,HIV
24. Hard exudate
Deep yellow with sharp margins
Often circinate
Leakage from pre-capillary arterioles
DM, HTN, VHL disease, radiation
„Macular fan‟
Soft exudate(cotton wool spot)
Fluffygray-white, near optic disc
Retinal nerve fiber layer microinfarction
HTN, DM, connective tissue disease,HIV
25. White centered retinal haemorrhages
CWS surrounded by h‟mage
CWS- ischaemic axons
H‟maghe- precapillary arterioles
Sub acute bacterial endocarditis
Leukaemia
Diabetes
26. Deposition in ganglion cell layer
Thickening & loss of
transparency of retina
Foveola-ganglion cells absent,
thin, so contrast
Sphingolipidoses
Central retinal artery occlusion
Berlins edema
27. Crack like dehiscence in brusch‟ membrane
Degenerative process combined with calcium
deposition
Linear reddish brown lesion
Lies beneath normal blood vessels
“Pseu d‟orange”
Salmon spots, optic nerve drusen
Pseudoxanthoma elasticum, EDS
Paget‟s, Hemoglobinopathies
36. Atherosclerosis, embolism
Retina appears white
Attenuation of arteries and
veins
Cherry red spot
Investigate for
Valvular heart disease,
endocarditis, mural thrombi,
Carotid artery disease, systemic
vasculitis, hematological
disorders
37. Atherosclerosis, embolism Cattle-trucking
Retina appears white
Attenuation of arteries and
veins
Cherry red spot
Investigate for
Valvular heart disease,
endocarditis, mural thrombi,
Carotid artery disease, systemic
vasculitis, hematological
disorders
38. Embolism, periarteritis
Retinal cloudiness
corresponding to the areas of
ischemia
Narrowing of arteries and
veins
One or more emboli may be
present
39. Present in 20% of population
It may be isolated, combined
CRVO, combined AION
Localised cloudiness- macula
and papillomacular bundle
40. Occlusion of short posterior ciliary arteries
Disc is pale
Diffuse or sectoral edema
Splinter shaped h‟mages
„Pseudo-Foster kennedy syndrome‟
41. Giant cell arteritis
Cotton wool spots are uncommon
Cilioretinal artery occlusion
Central artery occlusion
53. Primary response to HTN- vasoconstriction
Narrowing depend on pre-existing sclerosis
Narrowing seen in its pure form only in
young individuals
Sustained HTN-inner BRB disrupted
Increased vascular permeability
Narrowing and sclerosis suggests duration of
hypertension
84. No typical features
Retinopathy
Haemorrhages
Cotton wool spots
Vascular occlusions
85.
86. Hyaline like calcific material within optic disc
Often bilateral, 0.3%
Buried drusen
Elevated disc, scalloped margin
No physiological cup
No hyperaemia
Vessels not obscured
Venous pulsation present
Exposed drusen
Waxy pearl like irregularities
87. Hyaline like calcific material within optic disc
Often bilateral, 0.3%
Buried drusen
Elevated disc, scalloped margin
No physiological cup
No hyperaemia
Vessels not obscured
Venous pulsation present
Exposed drusen
Waxy pearl like irregularities
88. Hyaline like calcific material within optic disc
Often bilateral, 0.3%
Buried drusen
Elevated disc, scalloped margin
No physiological cup
No hyperaemia
Vessels not obscured
Venous pulsation present
Exposed drusen
Waxy pearl like irregularities
89. Incomplete closure of the choroid fissure
Discrete, focal, glistening, white,
bowl shaped excavation
Disc may enlarged
Retinal vasculature normal
Complication- RD
Trisomy 13, 18, 22
CHARGE
90. Visual acuity very poor
Enlarged disc with funnel shaped excavation
Central core -whitish glial tissue
Spokes of wheel appearance
Complication- RD
Frontonasal dysplasia
Neurofibromatosis type-2
91. Myelination extend to retina
Don‟t interfere with vision
Larger & denser than CWS
Always connected to optic disc
No overlying vitreous haze
93. Inflammatory, infective or demyelinating process
Retrobulbar neuritis
Opticdisc normal
Most common type in adult, MS
Papillitis
Hyperemia & edema of optic disc
Flame h‟mage
Neuroretinitis
Papiiltiswith retinal nerve fibre layer inflammation
Macular star
Viral infection , cat scratch fever, syphilis
94. Inflammatory, infective or demyelinating process
Retrobulbar neuritis
Opticdisc normal
Most common type in adult, MS
Papillitis
Hyperemia & edema of optic disc
Flame h‟mage
Neuroretinitis
Papiiltiswith retinal nerve fibre layer inflammation
Macular star
Viral infection , cat scratch fever, syphilis
95. Inflammatory, infective or demyelinating process
Retrobulbar neuritis
Opticdisc normal
Most common type in adult, MS
Papillitis
Hyperemia & edema of optic disc
Flame h‟mage
Neuroretinitis
Papiiltiswith retinal nerve fibre layer inflammation
Macular star
Viral infection , cat scratch fever, syphilis
96. Swelling of optic nerve head secondary to
raised intracranial pressure
Early papilloedema
Optic disc- hyperemia
& mild elevation
Disk margins indistinct
Loss of spontaneous
venous pulsation
97. Established papilloedema
Hyperaemia of optic disc
Blurred, elevated margin
Obliterated cup
Venous engorgement
Flame shaped hemorrhages
Cotton wool spots
Hard exudates-‛macular fan‟
98. Chronic papilloedema
Optic disc elevated and white
‛champagne cork appearance‟
Usual cause chronic elevated ICT
Corpora amylacea
Irreversible visual loss
Cotton wool spot & h‟mage
absent
99. Retro laminar portion of optic
nerve to lateral geniculate body
Lesion anterior to optic chiasma-
unilateral
RB neuritis, hereditary,
compressive lesions, toxic&
nutritional optic neuropathy
Without antecedent swelling of
optic disc
Pale flat disc, clear margins
Reduction in no. of small BV on
the disc- „Kestenbaum sign‟
Atrophy may be diffuse/sectoral
100. Retro laminar portion of optic
nerve to lateral geniculate body
RB neuritis, hereditary,
compressive lesions, toxic&
nutritional optic neuropathy
Without antecedent swelling of
optic disc
Lesion anterior to optic chiasma-
unilateral
Pale flat disc, clear margins
Reduction in no. of small BV on
the disc- „Kestenbaum sign‟
Atrophy may be diffuse/sectoral
101. Preceded by swelling
Papilloedema, AION, Optic neuritis
Dirty grey slightly raised disc
Ill defined margins –gliosis
Sheathed vessels
Reduction in small vessels
102.
103. Clinical opthalmology- Jack J.Kanski 5th Ed.
“The Eyes Have It”-University of Michigan
Harrison‟s Principles of internal medicine 16th Ed.
Parsons‟ Diseases of the Eye 20th Ed.
New England Journal of Medicine