FUNDOSCOPY IN PIH RETINA FUNDOSCOPY PIH Mirror to the cardiovascular system of the body FUNDOSCOPY Visualization of hypertensive changes PIH Retinal changes run parallel with the severity of hypertension hence that of pre-eclampsia.

PROCEDURE ONE DROP EVERY 10 MINUTES THREE TIMES FUNDOSCOPY AFTER ONE HOUR BEFORE FOUR HOURS

SYSTEMIC HYPERTENSION VASOSPASM VASOSCLEROSIS RETINOPATHY

NORMAL FUNDUS Uniform Caliber Smooth sinuous course Brach at obtuse angle

VASOSPASM NARROWING STRAIGHTENING ACUTE ANGLED BRANCHING A-V RATIO 1:3

Deflection in the course of the vein at the Arterio-venous crossing VASOSCLEROSIS SALU’S SIGN Deflection in the course of the vein at the Arterio-venous crossing

Concealment of the vein at the Arterio-venous crossing VASOSCLEROSIS GUNN’S SIGN Concealment of the vein beneath the artery at the Arterio-venous crossing

RETINOPATHY SOFT EXUDATES RETINAL HEMORRHAGES RETINAL EDEMA HARD EXUDATES RETINAL DETACHMENT

RETINOPATHY Occulsion of precapillry arteriole Capillary nonperfusion SOFT EXUDATES Occulsion of precapillry arteriole Capillary nonperfusion Localised axoplasmic stasis Compact yellowish white fluffy lesions Cotton wool spots

RETINOPATHY Fibrinoid necrosis in the vessel wall FLAME SHAPED HAEMORRGHAGES Fibrinoid necrosis in the vessel wall Located in the Nerve fibre layer of retina Bright red flamed shaped hemorrhage

RETINOPATHY Increased capillary Permeability Retinal edema MACULAR STAR HARD EXUDATES Increased capillary Permeability Retinal edema Precipitation of lipids Discrete dense yellow lesions Macular star

Accumulation of Serous fluid Retinal pigment epithelium RETINAL DETACHMENT LOCALISED RETINAL DETACHMENT Accumulation of Serous fluid between Retinal pigment epithelium and Neurosensory retina

RETINAL DETACHMENT TOTAL BULLOUS DETACHMENT

OPTIC DISC EDEMA MALIGNANT HYPERTENSIVE RETINOPATHY

KEITH-WAGENER-BARKER 1939 FEATURES K-W-R GRADING SURVIVAL Narrowing of the retinal arteries I EXCELLENT A-V CHANGES SALU’S SIGN AND GUNN’S SIGN II GOOD RETINOPATHY SOFT EXUDATES FLAME HAEMORRHAGES HARD EXUDATES RETINAL EDEMA/RETINALDetachment III POOR DISC EDEMA IV VERY POOR

AMERICAN OPHTHALMOLOGICAL SOCEITY K-W-R GRADING AOA FEATURES O Normal fundus I II Focal Narrowing Diffuse generalised narrowing III RETINOPATHY SOFT EXUDATES/FLAME HAEMORRHAGES RETINAL EDEMA/RETINAL DETACHMENT IV DISC EDEMA

IMPLICATION FEATURES PREGNANCY CONTINUE RETINOPATHY TERMINATE NORMAL FUNDUS CONTINUE FOCAL NARROWING DIFFUSE NARROWING RETINOPATHY SOFT EXUDATES FLAME HAEMORRHAGES HARD EXUDATES RETINAL EDEMA/RD TERMINATE DISC EDEMA

FUNDOSCOPY IN PIH CONTINUE TERMINATE

PROGNOSIS

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