Fundscpic examinatin
Fundscpic Examinatin Windw t the bld vessels Prerequisites- n Gd phthalmscpe n A large pupil n A still field
Fundscpic Examinatin Diminish illuminatin in the rm( t vercme light reflex) Instruct the pt t lk at a distant pint, which is clearly defined( t vercme accmdatin and keeping the eye still) Rt eye fr examining rt fundus, lt eye fr left fundus
Fundscpic Examinatin First find the ptic disc n Clur n Edges n Optic cup n Nasal blurring, tempral pallr- Nrmal Vessels n CRA- superir and inferir branches, nasal & tempral br-fur prminent arterial trunks emanating frm the disc n Vns are larger and darker n Arteries are lighter and narrwer than vns and ften have a central reflecting line silver-wire appearance n Pint f crssing f arteries and vns Haemrrhage and exudates Macula, Peripheral retina
Nrmal Ocular Fundus Arteriles Fvea Optic cup Optic disc Vein
Fundscpic Examinatin Cup t Disk Rati n Diameter f the cupped regin f the ptic nerve head divided by the diameter f the ptic nerve head. C/D = 0.6 Nrmal is ~0.3-0.5. Abnrmal values are higher and are assciated with glaucma
Cttn Wl Spts Cttn wl spts result frm cclusin f retinal pre-capillary arteriles supplying the nerve fibre layer with cncmitant swelling f lcal nerve fibre axns. Als called "sft exudates" r "nerve fibre layer infarctins" they are white, fluffy lesins in the nerve fibre layer. Papilledema, HTN, PAN, retinal emblism, severe anaemia
Hard exudates Hard exudates ( Intraretinal lipid exudates ) are yellw depsits f lipid and prtein within the retina. Accumulatins f lipids leak frm surrunding capillaries and micraneurysms, they may frm a circinate pattern. Hyperlipidemia may crrelate with the develpment f hard exudates.
Papilledema- Definitin Swelling f ptic disc Arbitrarily, the term has been reserved fr the passive disc swelling assciated with raised ICP Usually bilateral, althugh it may be asymmetrical
Causes f papilledema (Raised ICP)
Clinical Features f Papilledema Usually bilateral but may be unilateral r asymmetric Usually preserved visual acuity and clr visin early May have transient visual lss lasting secnds (bscuratins f visin) Visual field defects n Enlarged blind spt n Generalized cnstrictin n Glaucmatus-like defects n Eventual peripheral cnstrictin, especially nasally N afferent pupillary defect
Papilledema shwing blurred disc margins and dilated trtuus vessels
Early papilledema Minimal disc hyperemia with capillary dilatin Early pacificatin f nerve fiber layer (peripapillary retina lses its superficial linear and curvilinear light reflex and appears red withut luster) Early swelling f disc Absence f venus pulsatins Peripapillary retinal nerve fiber layer hemrrhage
Fully develped papilledema Engrged and trtuus retinal veins May have splinter hemrrhages at r adjacent t the disc margin Disc surface grssly elevated Surface vessels becme bscured by nw paque nerve fiber layer May have cttn wl spts Patn s lines (circumferential retinal flds) r chridal flds Hemrrhage and exudates In acute cases (e.g., subarachnid hemrrhage), subhyalid hemrrhages may ccur that may break int vitreus (Tersn s syndrme)
Frisen Papilledema Grading System Stage 1 Obscuratin f the nasal brder f the disc N elevatin f the disc brders Disruptin f the nrmal radial nerve fiber layer (NFL) arrangement with grayish pacity accentuating nerve fiber bundles Nrmal tempral disc margin Subtle grayish hal with tempral gap C-shaped hal with a tempral gap
Frisen Papilledema Grading System Stage 2 Obscuratin f all brders Elevatin f nasal brder Cmplete peripapillary hal Hal becmes circumferential
Frisen Papilledema Grading System Stage 3 Obscuratin f all brders Elevatin f all brders Increased diameter f the ptic nerve head Obscuratin f ne r mre segments f majr bld vessels leaving the disc Peripapillary hal irregular uter fringe with finger-like extensins Lss f majr vessels as they leave the disc (arrw)
Frisen Papilledema Grading System Stage 4 Elevatin f entire nerve head Obscuratin f all brders Peripapillary hal Ttal bscuratin n the disc f a segment f a majr bld vessel lss f majr vessels ON THE DISC
Grade IV plus partial r ttal bscuratin f all vessels f the disc Frisen Papilledema Grading System Stage 5 Dme-shaped prtrusins representing anterir expansin f the ptic nerve head Peripapillary hal is narrw and smthly demarcated Ttal bscuratin f a segment f a majr bld vessel may r may be present Obliteratin f the ptic cup
Pseudpapilledema Optic nerve drusen Medullated nerve fiber Hypermetrpic disc Cngenital anmalus elevatin
Optic atrphy - Definitin Optic nerve shrinkage frm any prcess that prduce degeneratin f axns in the ant.visual (Retingeniculate) pathway
CLASSIFICATION OF OPTIC ATROPHY PRIMARY SECONDARY Pst- papilledemic ptic atrphy Pst-Neuritic ptic atrphy Glaucmatus ptic atrphy Cnsecutive ptic atrphy
PRIMARY OPTIC ATROPHY Optic nerve fibers degenerate in an rderly manner and are replaced by clumns f glial cells withut alteratin in the architecture f the ptic nerve head Pale disc Chalky white(full mn against a dark red sky) Clear margin f disc/ sharply demarcated Nrmal cup Well seen lamina cribrsa Nrmal retinal vessels
Secndary ptic atrphy Optic nerve fibers exhibit marked degeneratin, with excessive prliferatin f glial tissue The architecture is lst, resulting in indistinct margins. The disc is grey r dirty grey, lks pale with a greenish tinge The margins are prly defined, The lamina cribrsa is bscured due t prliferating fibrglial tissue. Hyaline bdies (crpra amylacea) r drusen may be bserved. Peripapillary sheathing f arteries as well as trtuus veins may be bserved.
Secndary ptic atrphy
OPTIC ATROPHY The Kestenbaum cunt is the number f capillaries bserved n the ptic disc. The nrmal cunt is apprximately 10. In ptic atrphy, the number f these capillaries reduces t less than 6; in a hyperemic disc, the cunt is mre than 12