FUNDUS EXAMINATION FUNDUS EXAMINATION IN HYPERTENSIVESIN HYPERTENSIVES

METHODSMETHODSDIRECT DIRECT OPHTHALMOSCOPY OPHTHALMOSCOPY -- HELMHOLTZHELMHOLTZMagnification Magnification --1414--16 times16 timesMono ocularMono ocularRequires clear mediumRequires clear mediumRetinal periphery not visualisedRetinal periphery not visualisedIndirect ophthalmoscopyIndirect ophthalmoscopy--c.Ruetec.RueteMagnification 4Magnification 4--5 times5 timesBinocularBinocularInverted imageInverted imageSlit lamp biomicroscopySlit lamp biomicroscopyFundus fluorescein angiographyFundus fluorescein angiography

PROCEDUREPROCEDURE

DIRECT OPHTHALMOSCOPY:DIRECT OPHTHALMOSCOPY:Dark roomDark roomMydriasisMydriasisPatient’s positionPatient’s positionExaminer’s positionExaminer’s positionDistant direct ophthalmoscopyDistant direct ophthalmoscopy--Red reflexRed reflex

NORMAL FUNDUSNORMAL FUNDUSOPTIC DISC:OPTIC DISC:Neuroretinal rimNeuroretinal rimOptic cupOptic cupCup to disc ratioCup to disc ratioBLOOD SUPPLY:BLOOD SUPPLY:Av crossingsAv crossingsArteriolar light reflexArteriolar light reflexMaculaMaculaFovea Fovea -- foveal avascular zonefoveal avascular zoneFoveolaFoveolaBackground fundusBackground fundus

NORMAL FUNDUS WITH OPTIC DISC AND NORMAL FUNDUS WITH OPTIC DISC AND MACULAMACULA

KEITH WAGNER BARKER CLASSIFICATIONKEITH WAGNER BARKER CLASSIFICATION

GRADE 1GRADE 1:: Sclerosis of arterioles Sclerosis of arterioles –– focal focal \\ diffuse diffuse constriction, constriction, copper copper -- wire and silverwire and silver--wire arteriolar wire arteriolar reflexreflex

GRADEGRADE 22:: Av crossing changesAv crossing changesGunn sign, salus sign, bonnet signGunn sign, salus sign, bonnet sign

GRADEGRADE 3:3: FLAME SHAPEDFLAME SHAPED Hemorrhages,Hemorrhages,cotton wool cotton wool spots, spots, retinal edema,retinal microaneurysymsretinal edema,retinal microaneurysyms

GRADEGRADE 4:4: GRADE 3 CHANGES WITH GRADE 3 CHANGES WITH PAPILLEDEMAPAPILLEDEMA WITH OR WITHOUT WITH OR WITHOUT MACULAR MACULAR STARSTAR

GRADE 1: FOCAL ARTERIAL NARROWINGGRADE 1: FOCAL ARTERIAL NARROWING

GRADE 2: CHANGES AT AV CROSSINGSGRADE 2: CHANGES AT AV CROSSINGS

GRADE 3: GRADE 3: COTTON WOOL SPOTSCOTTON WOOL SPOTSDIFFUSE ARTERIOLAR NARROWINGDIFFUSE ARTERIOLAR NARROWING

GRADE 4:GRADE 4:�� Cotton wool spotsCotton wool spots�� Flame shaped hemorrhagesFlame shaped hemorrhages�� Macular starMacular star�� Early papilledemaEarly papilledema

�� Hypertensive choroidopathyHypertensive choroidopathy�� Seigrist linesSeigrist lines�� Elschnig spotsElschnig spots

COURSE AND PROGNOSISCOURSE AND PROGNOSIS

�� Indicator of underlying Indicator of underlying vascular compromisevascular compromise�� Usually asymptomaticUsually asymptomatic�� Visual lossVisual loss -- Macular edema,branch retinal Macular edema,branch retinal

vein occlusion, malignant hypertensionvein occlusion, malignant hypertension�� Control of hypertensionControl of hypertension�� Usually resolves with timeUsually resolves with time