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Diabetic Exam
Diabetic Exam
Poor diabetic control may manifest in many different ways, with macrovascular and microvascular complications. The diabetic examination is useful for diagnosing these complications, particularly when it comes to the vascular and neurologic examination of the lower limb.




  • In diabetics, always ask to perform fundoscopy. This may provide valuable information regarding the presence of diabetic retinopathy.
    • 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): 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, SAH, DIC
    • Roth spots: haemorrhages with pale centresInfective endocarditis
    • Emboli: small white flecks over vessels, with distal narrowing.Generally cholesterol emboli from carotid artery disease

Diabetic Retinopathy

  • Retinal disease of the eye in diabetics manifests initially as small haemorrhages, while in advanced disease the eye develops new blood vessels that are at risk of major bleeding.
    • Signs of Diabetic Retinopathy

    • Microaneurysms: tiny dot-like outpouchings
    • Cotton wool spots
    • Haemorrhages (small dots)
    • Macular oedema
    • Neovascularisation: formation of abnormal and fragile vessels
Last updated on November 28th, 2019

Associated Diseases