Fundus in clinical medicine

Takayasu arteritisMikito takayasu – Japanese ophthalmologistHe reported the asssociation of retinal

arteriovenous anastamoses with absent upper extremity pulses

Chronic inflammatory disease of aorta and branches

Called as pulseless disease.

Fundoscopic features1.Retinal hemorrhaghes2.Cotton wool exudates3.Venous dilatation and beading

Takayasu arteritis

Cloudy retinal swellingBreak up of blood column in

arteryFundus findings

1.Microaneurysms2.Neovascular glaucoma3.Ischemic optic neuropathy4.Classic “wreath like” peripapillary arteriovenous anastamoses……….

Behcets syndrome

Chronic , relapsing vasculitisNamed after Turkish dermatologistCharacterised by1.Recurrent aphthous ulcer2.Genital ulceration3.Arthalgia4.Recurrent uveitis and retinal vasculitis5.Skin lesions6.Positive pathergy test

Behcets disease

The picture shows 1.Soft exudates2.Intraretinal hemorrhaghes1.Retinal infiltrates

2.Periphlebitis3.Occlusive disease4.Retinal vasculitis5.Optic disc vasculitis6.Chorioretinal scar

SarcoidosisMultisystem granulomatous diseaseMost affected organs lungs skin eyeFrequency of ocular involvement 30 – 50 %

Pan uveitis is commonNodules are seen in conjuctiva, uvea and choroid

sarcoidosis1.Snow ball vitreous opacities in sarcoid uveitis2.Periphlebitis3.Choroidal infiltrates4.Choroidal granuloma5.Retinal vasculitis , new vessels in optic disc6.Punched out chorioretinal lesions

sarcoidosis1.Candle wax drippings2.Retinal sarcoid granuloma3.Granuloma in optic disc

Giant cell arteritisAlso called as temporal arteritisInflammatory disease of large vsselsMean age of presentation 70 yrsRapidly progressing vision loss

GCAOphthalmic , posterior choroidal arteries are commonly involved

Anterior Ischemic Optic neuropathyCommones t cause of vision loss

Choroidal infarcts can occur

Vogt koyanagi harada syndromeUveo dermatological syndromeSystemic disease involving melanocyte containing

organsCharacterised by1.Bilateral uveitis2.Cutaneous3.Neurological4.Auditory abnormalities

VKH syndrome1.Sunset glow fundus2.Multiple retinal detachment3.Dalen Fuchs nodules in choroid4.Subretinal fibrosis

Neurodegenrerative disease with specific fundus findings

1.Freidrichs ataxia2.Spinocerebellar ataxia3.Inherited mitochondrial diseasesMetabolic diseases1.Niemann Picks disease2.Tay Sachs

Friedrichs ataxiaInherited diseaseProgressive neurological illness involving cortico spinal tract, posterior columnRetinitis pigmentosaDeafnessdilated cardiomyopathyPes cavusAutosomal recessive

Mitochondrial disease1.Kearns Sayre disease2.MELAS3.Mitochondrial myopathiesLebers hereditary optic neuropathyNeuropathy, ataxia retinitis PigmentosaLeighs syndrome

Cherry red spot in fundus1.Tay sachs disease2.Niemann Picks 3.CRVO4.CRAO5.Sandhoffs disease6.Sialidosis7.Gauchers

Optic neuritisMost common etiology

Multiple sclerosis

Loss of colour vision is the earliest manifestation

Papilledema

1.Meningitis, Encephalitis2.Venous sinus thromb osis3.Tumours4.Idiopathic Intracranial hypertension

Others……..

Purtshners retinopathySickle cell retinopathyRoth spotsLeopard spot fundus

Purtschners retinopathy

Caused in1.Acute pancreatitis2.Lymphoma3.Thrombotic thrombocytopenic purpura

Due to, Microvascular damage with occlusion And Ischemia of retinal vessels

Multiple white retinal patches

Roth spots

1.Infective endocarditis2.Severe anaemia3.Leukemia

Leopard spot fundus

leukemia

Sickle cell retinopathy

Tractional retinal detachment

Phacomatoses1.Von hippel lindau syndrome2.Tuberous sclerosis3.Neurofibroma

Tuberous sclerosisAdenoma sebaceumEpilepsyGiant cell astrocytoma

Fundus

Retinal hamartoma are common

Von Hippel LindauRetinal hemangioblastoma can occur

Chromosome 3