FUNDOSCOPY FUNDOSCOPY ININ PIH PIHRETINA RETINA

Mirror to the cardiovascular system of the Mirror to the cardiovascular system of the bodybody

FUNDOSCOPYFUNDOSCOPYVisualization of hypertensive changesVisualization of hypertensive changes

PIHPIHRetinal changes run parallel with the severity Retinal changes run parallel with the severity of hypertension hence that of pre-eclampsia.of hypertension hence that of pre-eclampsia.

PROCEDUREPROCEDURE

ONE DROPEVERY 10 MINUTESTHREE TIMES

FUNDOSCOPYAFTER ONE HOURBEFORE FOUR HOURS

SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION

VASOSPASMVASOSPASM

VASOSCLEROSISVASOSCLEROSIS

RETINOPATHYRETINOPATHY

NORMAL FUNDUSNORMAL FUNDUS

Uniform CaliberUniform Caliber

Smooth sinuous Smooth sinuous coursecourse

Brach at obtuse Brach at obtuse angleangle

VASOSPASMVASOSPASM

NARROWINGNARROWING

STRAIGHTENINGSTRAIGHTENING

ACUTE ANGLEDACUTE ANGLED

BRANCHINGBRANCHING

A-V RATIO 1:3A-V RATIO 1:3

VASOSCLEROSISVASOSCLEROSIS

SALU’S SIGNSALU’S SIGNDeflection in the course of the vein at Deflection in the course of the vein at

the Arterio-venous crossingthe Arterio-venous crossing

VASOSCLEROSISVASOSCLEROSIS

GUNN’S SIGNGUNN’S SIGNConcealment of the veinConcealment of the vein

beneath the artery beneath the artery

at the Arterio-venous crossingat the Arterio-venous crossing

RETINOPATHYRETINOPATHY

SOFT EXUDATESSOFT EXUDATESRETINAL HEMORRHAGESRETINAL HEMORRHAGES

RETINAL EDEMARETINAL EDEMAHARD EXUDATESHARD EXUDATES

RETINAL DETACHMENTRETINAL DETACHMENT

RETINOPATHYRETINOPATHY

Occulsion of precapillry arterioleOcculsion of precapillry arterioleCapillary nonperfusionCapillary nonperfusionLocalised axoplasmic stasisLocalised axoplasmic stasisCompact yellowish white fluffy lesionsCompact yellowish white fluffy lesionsCotton wool spotsCotton wool spots

SOFT EXUDATES

RETINOPATHYRETINOPATHY

Fibrinoid necrosis in the vessel wallFibrinoid necrosis in the vessel wall

Located in the Nerve fibre layer of retinaLocated in the Nerve fibre layer of retina

Bright red flamed shaped hemorrhageBright red flamed shaped hemorrhage

FLAME SHAPEDHAEMORRGHAGES

RETINOPATHYRETINOPATHY

Increased capillary PermeabilityIncreased capillary Permeability

Retinal edemaRetinal edema

Precipitation of lipidsPrecipitation of lipids

Discrete dense yellow lesions Discrete dense yellow lesions

Macular starMacular star

HARD EXUDATES

MACULAR STAR

RETINAL DETACHMENTRETINAL DETACHMENT

Accumulation of Serous fluid between

Retinal pigment epithelium and

Neurosensory retina

LOCALISED RETINAL DETACHMENT

RETINAL DETACHMENTRETINAL DETACHMENT

TOTAL BULLOUS DETACHMENT

OPTIC DISC EDEMAOPTIC DISC EDEMA

MALIGNANT HYPERTENSIVE RETINOPATHY

KEITH-WAGENER-BARKERKEITH-WAGENER-BARKER19391939

FEATURESFEATURES K-W-R K-W-R GRADINGGRADING

SURVIVALSURVIVAL

Narrowing of the retinal arteriesNarrowing of the retinal arteries II EXCELLENTEXCELLENT

A-V CHANGESA-V CHANGESSALU’S SIGN AND GUNN’S SIGNSALU’S SIGN AND GUNN’S SIGN

IIII GOODGOOD

RETINOPATHYRETINOPATHYSOFT EXUDATESSOFT EXUDATES

FLAME HAEMORRHAGESFLAME HAEMORRHAGES

HARD EXUDATESHARD EXUDATES

RETINAL EDEMA/RETINALRETINAL EDEMA/RETINALDetachmentDetachment

IIIIII POORPOOR

DISC EDEMADISC EDEMA IVIV VERY POORVERY POOR

AMERICAN AMERICAN OPHTHALMOLOGICAL SOCEITYOPHTHALMOLOGICAL SOCEITY

K-W-RK-W-R

GRADINGGRADINGAOAAOA

GRADINGGRADINGFEATURESFEATURES

OO Normal fundusNormal fundus

II I I

IIII

Focal NarrowingFocal Narrowing

Diffuse generalised narrowingDiffuse generalised narrowing

IIII

IIIIII IIIIII RETINOPATHYRETINOPATHYSOFT EXUDATES/FLAME HAEMORRHAGESSOFT EXUDATES/FLAME HAEMORRHAGES

RETINAL EDEMA/RETINAL DETACHMENTRETINAL EDEMA/RETINAL DETACHMENT

IVIV IVIV DISC EDEMADISC EDEMA

IMPLICATIONIMPLICATION

FEATURESFEATURES PREGNANCYPREGNANCYNORMAL FUNDUSNORMAL FUNDUS

CONTINUECONTINUEFOCAL NARROWINGFOCAL NARROWING

DIFFUSE NARROWINGDIFFUSE NARROWING

RETINOPATHYRETINOPATHYSOFT EXUDATESSOFT EXUDATES

FLAME HAEMORRHAGESFLAME HAEMORRHAGES

HARD EXUDATESHARD EXUDATES

RETINAL EDEMA/RDRETINAL EDEMA/RD

TERMINATETERMINATE

DISC EDEMADISC EDEMA

FUNDOSCOPY IN PIHFUNDOSCOPY IN PIH

CONTINUE

TERMINATE

PROGNOSISPROGNOSIS