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. Normal fundus
Optic disc Optic cup
Macula
Superior
temporal
vein
Superior
nasal vein
Inferior
temporal
vein
Inferior
nasal vein
Superior
temporal
artery
Fovea
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. 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. 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. 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?
14. Dilated vein
Describe what you see
What systemic disease are these signs associated
with?
Microaneurys
m
Diabetes Mellitus
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. 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. What has happened here?
Pan Retinal Photocoagulation (PRP)
PRP is used in the treatment of proliferative diabetic retinopathy
18. Macular
star
What are these arrows pointing at?
What condition is this feature associated with?
Hypertensio
n
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. 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. What is your diagnosis?
Central Retinal Vein Occlusion
(CRVO)
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. Describe the fundal changes
What is your
diagnosis?
Hyperpigmentation and drusen of the macula
Dry Age Related Macular Degeneration (ARMD)
24. What is the name of this type of macular degeneration?
Disciform macular degeneration/ Wet ARMD
25. What types of lesion are these ?
What is the most likely cause of this lesion?
Chorioretinal scars
Toxoplasmosis
Old lesion
Active lesion
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?
