Fundus Examination In Hypertensives

FUNDUS EXAMINATION IN HYPERTENSIVES

METHODS DIRECT OPHTHALMOSCOPY - HELMHOLTZ Magnification -14-16 times Mono ocular Requires clear medium Retinal periphery not visualised Indirect ophthalmoscopy-c.Ruete Magnification 4-5 times Binocular Inverted image Slit lamp biomicroscopy Fundus fluorescein angiography

PROCEDURE DIRECT OPHTHALMOSCOPY: Dark room Mydriasis Patient’s position Examiner’s position Distant direct ophthalmoscopyRed reflex

NORMAL FUNDUS OPTIC DISC: Neuroretinal rim Optic cup Cup to disc ratio BLOOD SUPPLY: Av crossings Arteriolar light reflex Macula Fovea - foveal avascular zone Foveola Background fundus

NORMAL FUNDUS WITH OPTIC DISC AND MACULA

KEITH WAGNER BARKER CLASSIFICATION GRADE 1: Sclerosis of arterioles – focal \ diffuse constriction, copper - wire and silver-wire arteriolar reflex GRADE 2: Av crossing changes Gunn sign, salus sign, bonnet sign GRADE 3: FLAME SHAPED Hemorrhages,cotton wool spots, retinal edema,retinal microaneurysyms GRADE 4: GRADE 3 CHANGES WITH PAPILLEDEMA WITH OR WITHOUT MACULAR STAR

GRADE 1: FOCAL ARTERIAL NARROWING

GRADE 2: CHANGES AT AV CROSSINGS

GRADE 3: COTTON WOOL SPOTS DIFFUSE ARTERIOLAR NARROWING

GRADE 4: Cotton wool spots Flame shaped hemorrhages Macular star Early papilledema

Hypertensive choroidopathy Seigrist lines Elschnig spots

COURSE AND PROGNOSIS Indicator of underlying vascular compromise Usually asymptomatic Visual loss - Macular edema,branch retinal vein occlusion, malignant hypertension Control of hypertension Usually resolves with time