Overview
When performing a cardiovascular examination, always ask to perform fundoscopy. This may reveal signs of diabetic or hypertensive nephropathy.
How to Perform
- Dim the lights and examine the fundus using a traditional direct or PanOptic ophthalmoscope.
Dilate the eye if possible with tropicamide, atropine or phenylephrine eye drops.
Hypertensive Eye Changes
Look For
- Silver wiring: glistening bronze / silver arterial walls
- Arteriovenous nicking: arteries displacing veins at points of crossing
- Flame-shaped retinal haemorrhages
- Cotton wool spots: small white, cotton wool-like microinfarcts on the retina
- Papilloedema: swelling of the disc with venous engorgement, cotton wool spots and haemorrhage
Grading of Hypertensive Retinopathy
- Grade 1: silver wiring
- Grade 2: arteriovenous nicking
- Grade 3: flame-shaped haemorrhages, cotton wool spots
- Grade 4: papilloedema
Roth Spots
Seen on fundoscopic examination, Roth spots are a pale patch to the retina with a surrounding ring of haemorrhage.
Significance
- A peripheral sign of infective endocarditis.
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