Sat27November0445PM 33

A 54-year-old man complains of deterioration in his vision.

The fundoscopy finding below is seen on clinical examination:

How would you manage this patient?

(Please select 1 option)

Check blood pressure and aim for target of 130/80

Same day referral to ophthalmology This is the correct answer

Arrange blood testing for diabetes Incorrect answer selected

Routine referral to ophthalmology

Advise acuity check with local optometrist

Explanation

This patient has a retinal vein occlusion and should be referred to an ophthalmologist urgently.

Retinal vein occlusion usually occurs as a complication of hypertension or diabetes. The central retinal vein or a branch may be occluded; if the central vein is occluded then the whole retina is affected, whereas only a segment is affected in BRVO. The region tends to be dark, with (flame) haemorrhages and sometimes with cotton-wool spots. The complications are macular oedema and rubeosis iridis (neovascular glaucoma).

"Venous occlusive disease is second to diabetic retinopathy as the most common retinal vascular disease. Prompt diagnosis and timely referral for laser photocoagulation therapy will help patients avoid devastating complications such as neovascular glaucoma and chronic macular oedema. New, unique and promising techniques are on the near horizon in the more proactive treatment of venous occlusive disease. Patients with BRVO have retinal haemorrhages confined to the distribution of the retinal vein.

The ophthalmoscopic examination may note triangular and flame-shaped haemorrhages.

Mild obstruction of a branch may only show scant haemorrhage. Complete obstruction may have extensive haemorrhage noted on examination, with cotton wool spots."1

Reference:

Prakash G, Agarwal T, Kumar A. Fundus Examination. JIACM 2005;6):254-5.

Answer Statistics

1

39%

2

52%

3

7%

4

1%

5

2%

Times answered: 290