fundoscope finding in diabetic retinopathy for non opthalmologist

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fundoscopIC finding in diabetic retinopathy for non opthalmologist:

M ohammed abdelsattar fundoscop IC finding in diabetic retinopathy for non opthalmologist

Macula :

Macula oval-shaped pigmented area near the center of the retina of the human eye . The macula co ntain of light sensitive photoreceptors that are densely packed together The fovea centralis It is a small, central pit composed of closely packed cones. It is located in the center of the macula This enables the macula to be in control of the central vision and the ability to do tasks like reading, distinguishing faces or details and driving .

optic disc :

optic disc is the point of exit for ganglion cell axons leaving the eye. Because there are no rods or cones overlying the optic disk, it corresponds to a small physiological blind spot in each eye . The optic cup is the white, cup-like area in the center of the optic disc The ratio of the size of the optic cup to the optic disc is measured to diagnose glaucoma. A normal cup to disc ratio is 0.3 a larger ratio suggests glaucoma.

Retina :

Retina light-sensitive layer of tissue, lining the inner surface of the eye. The retina is a layered structure with several layers of neurons interconnected by synapses The only neurons that are directly sensitive to light are the photoreceptor cells mainly of two types: the rods and cones . Rods function mainly in dim light and provide black-and-white vision, while cones support daytime vision and the perception of colour

Types of Diabetic Retinopathy :

Types of Diabetic Retinopathy two main categories of diabetic retinopathy : Non-proliferative : The small blood vessels in the retina become damaged and can leak fluid into the retinal tissue. This is called macular edema, which is swelling of the retina in the area that serves central vision. not require treatment but need to be monitored closely

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Proliferative : Newly formed abnormal blood vessels develop along the surface of the retina and are very fragile. Their fragility can cause them to bleed, which can cause severe vision loss and even blindness. As these vessels proliferate, bleed and subsequently scar, they can detach the retina.

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Both proliferative diabetic retinopathy and diabetic macular oedema  can be treated and managed if they are detected early enough. If they are left untreated, sight problems will develop.



Cotton wool spots or soft exudate:

Cotton wool spots or soft exudate  are an abnormal finding on fundoscopic  exam of the retina of the eye. They appear as fluffy white patches on the retina. They are caused by occlustion of the precapillary arterioles supplying nerve fiber layers C a use nerve fiber infarction   they are one of the hallmarks of  pre-proliferative retinopathy

Hard exudate :

H ard exudate  They are the lipid residues of serous leakage from damaged capillaries . M ay form circinate pattern H yperlipedemia may be correlate with hard exudate development

Dot and blot haemorrhage:

D ot and blot   haemorrhage blot  haemorrhage   A  form of  intraretinal   haemorrhage  often noted in  background( nonproliferative )  The   haemorrhage  is located within the inner  retina A  small blot  haemorrhage  is  often referred  to as a  dot   haemorrhage .

Intraretinal microvascular abnormalities :

Intraretinal microvascular abnormalities   ( IRMA) are abnormalities of the blood vessels that supply the retina of the eye I ndicate sever non proliferative DR which will progress to proliferative DR. One way to distinguish IRMA from retinal neovascularization is to perform  fluorescein angiography V enous beading has an appearance resemble sussage appearance of retinal veins indicating severe NPDR .


stages Non proliferative diabetic retinopathy M ild M oderate S evere P roliferative diabetic retinopathy Diabetic maculopathy Advanced eye disease

Mild non proliferative dr:

Mild non proliferative dr At this earliest stage , microaneurysms occur . They are small areas of balloon-like swelling in the retina’s tiny blood vessels.

Mild non proliferative dr:

Mild non proliferative dr

Moderate Nonproliferative Retinopathy:

Moderate Nonproliferative Retinopathy As the disease progresses, some blood vessels that nourish the retina are  blocked Presence of microaneurysm B lot hge C otton wall spots and hard exudate S tart appearance of venous beading and intraretinal microvascular abnormalities

Severe Nonproliferative Retinopathy:

Severe Nonproliferative Retinopathy .  Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment . B lot hge and microvascular aneurysms in 4 quadrants V enous beading in at least 2 quadrants IRMA in at least 1 quadrant

Proliferative Retinopathy:

Proliferative Retinopathy  At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels . These new blood vessels are abnormal and fragile . They grow along the retina and along the surface of the clear they have thin, fragile walls . If they leak blood, severe vision loss and even blindness can result F ibrous tissue may be formed here. More ommon in type 1 DM.

Macular edema:

Macular edema  occurs when fluid and  protein deposits collect on or under the macula of the  eye and causes it to thicken and swell , The swelling may distort a person's central  vision C an occure in any stage of DR.   ME is the most common cause of visual loss in both proliferative, and non-proliferative diabetic retinoathy . M ore common in type 2 DM


FUNDUSCOPIC EXAMINATION Keep both yours and the person's eyes Have the patient focus on a distant object Look at right fundus with your right eye Ophthalmoscope should be close to your eyes. Your head and the scope should move together Set the lens opening at +8 to +10 diopters. With the ophthalmoscope 12-15 inches from the patient's eye, While adjusting the diopter setting, approach the patient more closely and systematically inspect the disc, noting the color, shape, margins and cup-to-disc ratio

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