Fundi (Images)

21 Fundi Nelson Ming-Sun Wat Case 21.1 Leading question A 52-year-old man complains of severely impaired visual acuity. Question 0 What is the diagnosis?

318 Problem-Based Medical Case Management Case 21.2 Answer * Atrophic papilloedema. Description ¢ Very pale white disc, slightly elevated with indistinct margins, also called “secondary optic atrophy” due to long standing papilloedema. Case 21.2 Leading question A 78-year-old man with a history of atrial fibrillation complains of sudden visual field loss. Question ¢ What is the diagnosis?

Case 21.3 Fundi 319 Answer Retinal artery occlusion. Discussion * What are the causes? — Emboli. — Atherosclerosis. Case 21.3 Leading question This 67-year-old patient complains of gradual loss of visual acuity. Question * What is the diagnosis?

320 Problem-Based Medical Case Management Case 21.4 Answer ¢ Central retinal vein occlusion. Description * There are tortuosity and dilatation of all branches of central retinal vein, with retinal haemorrhages throughout all 4 quad- rants. There is optic disc oedema and macular oedema. Case 21.4 Leading question A 60-year-old man with a history of diabetes complains of blurring of vision. Question * What is the diagnosis?

Case 21.5 Fundi 321 Answer + Laser photocoagulation scars. Discussion ¢ Photocoagulation if administered early can prevent blindness secondary to proliferative diabetic retinopathy. The best results in proliferative retinopathy are obtained before the onset of visual symptoms and tractional complications, and in macu- lopathy before severe visual loss. Case 21.5 Leading question A 64-year-old man with a history of hypertension complains of headache. Question What is the underlying condition?

322 Problem-Based Medical Case Management Case 21.6 Answer e Malignant hypertension. Description ¢ Cotton wool spot, flame-shaped haemorrhages, disc swelling, and macular star. Discussion ¢ Hypertensive fundi is distinguished from diabetic retinopathy which has blot and dot haemorrhages and well-circumscribed hard exudates. Laser scars are often present. However, the two conditions commonly coexist. Case 21.6 Leading question A 65-year-old woman presents with progressive blurring of vision.

Case 21.7 Fundi 323 Question » What is your diagnosis? Answer + Diabetic non-proliferative retinopathy. Microaneurysms, haem- orrhages, and hard exudates are seen. Discussion + May be completely asymptomatic. + Look out for other microvascular complications. * Prevent or delay worsening of diabetic retinopathy by more stringent diabetic and/or blood pressure control. Case 21.7 Leading question This patient complains of headache and transient visual blurring in both eyes for a few seconds.

324 Problem-Based Medical Case Management Case 21.8 Question * What is your diagnosis? Answer * Papilloedema. Description e Disc hyperemia, elevated with indistinct margins. There is venous engorgement, peripapillary flame shaped haemorrhages, cotton wool exudates. Visual acuity can be normal or reduced. Case 21.8 Leading question A 38-year-old woman complains of gradual loss of vision. Question * What is this abnormality?

Case 21.9 Fundi 325 Answer e Primary optic atrophy. Description « White, flat disc with clear margins. Discussion ¢ What are the common causes? - Retrobulbar neuritis. Compressive (tumours/aneurysms). Hereditary optic neuropathies. Toxic/nutritional optic neuropathies. | Case 21.9 Leading question This patient complains of blurring of vision.

326 Problem-Based Medical Case Management Case 21.10 Question What is your diagnosis? Answer ¢ Proliferative diabetic retinopathy. Description e New blood vessel formation at 12-2 o’clock region, with blot and dot haemorrhages at 4 o’clock. Case 21.10 Leading question A 72-year-old woman with diabetes and a previous history of laser photocoagulation treatment, complains of sudden loss of vision in one eye.

Case 21.10 Fundi 327 Question * What is the diagnosis? Answer + Vitreous haemorrhage and tractional retinal detachment. Discussion * Healed vitreous haemorrhage predisposed to future risk of retinal detachment.