Overview
When performing a cranial nerve examination, always ask to perform fundoscopy. This may provide valuable information regarding ocular or cranial nerve pathology, and reveals 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.
Interpretation
- Increased cup-disc ratio (>0.8, normally <0.5): the ratio of the size between the optic cup and the surrounding optic disc (entry point of the optic nerve and vessels)Glaucoma, giant cell arteritis, optic nerve compression / trauma / inflammation
- Papilloedema: swelling of the disc with venous engorgement, cotton wool spots and haemorrhageRaised ICP, severe hypertension
- Cotton wool spots: small white, cotton wool-like microinfarcts on the retinaHypertension, diabetes, HIV, anaemia, thrombocytopaenia, connective tissue disorders
- Arteriovenous nicking: arteries displacing veins at points of crossingHypertension
- Silver wiring: glistening bronze / silver arterial wallsHypertension
- Retinal haemorrhages - e.g. small dots or flame-shapedDiabetes, leukaemia, pernicious anaemia, subarachnoid haemorrhage, DIC
- Roth spots: haemorrhages with pale centresInfective endocarditis
- Emboli: small white flecks over vessels, with distal narrowing.Generally cholesterol emboli from carotid artery disease
Extra Credit
Signs of Diabetic Retinopathy
- Microaneurysms: tiny dot-like outpouchings
- Cotton wool spots
- Haemorrhages (small dots)
- Macular oedema
- Neovascularisation: formation of abnormal and fragile vessels
Signs of Hypertensive Retinopathy
- Grade 1 - silver wiring
- Grade 2 - arteriovenous nicking
- Grade 3 - flame-shaped haemorrhages, cotton wool spots
- Grade 4 - papilloedema
Next Page
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------