The initial bed-side investigation for Papilloedema is
Correct Answer: Fundoscopy
Description: (A) Fundoscopy# Examination of the Optic Fundus:> Overall shape of the disc: Is this a congenitally tilted disc?> Overall colour of the disc: Is the disc pale? Is there pigmentary abnormality suggesting a congenital abnormality (such as a coloboma--note that the pigmented temporal crescent most often seen in myopes is normal).> Size of the optic cup: Compared to the overall disc diameter, the cup: disc ratio is normally less than 0.7. Ratios greater than this are seen in conditions which cause nerve fibre loss--for example, glaucoma.> Vascular architecture: Do the vessels branch normally? Abnormalities such as trifurcations (as opposed to the normal bifurcations) are often associated with optic nerve head drusen.> Evidence of disc swelling: Is there venous pulsation? Absence of pulsation is the earliest sign of papilloedema, but it is absent in 20% of normal eyes.> In this case, it can often be elicited by gentle pressure on the eyeball. As the papilloedema worsens, the optic disc becomes raised, and exudates and haemorrhages may be seen> Changes in the surrounding retina. The following should be sought within the limits of pupillary dilatation: Hard and soft exudates, Microaneurysms and new vessel formation, Haemorrhages, Pigmentary changes (for example, "bone spicules" in retinitis pigmentosa, "salt and pepper" in mitochondrial disease) Macular changes (for example, pigmentary changes, oedema, cherry red spot).
Category:
Ophthalmology
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