Unit 6: Differential Diagnosis of Blurred Vision

Ocular manifestations of diabetes:

• Diabetic retinopathy
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  Diabetic Retinopathy

  

  Diabetic retinopathy

  Source: retinagallery.com

  Diabetic retinopathy refers to characteristic retinal abnormalities that occur throughout the retina, including retinal microhaemorrhage, exudates, and cotton wool spots (covered in more detail later on).

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• Diabetic maculopathy
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  Diabetic Maculopathy

  

  Diabetic Maculopathy

  Source: retinagallery.com

  Diabetic maculopathy refers to abnormalities involving the macular, most commonly macular oedema,

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  Macular Oedema

  

  Macular Oedema

  Source: retinagallery.com

  You will not need to remember this for examinations, but as background, macula oedema is ‘clinically significant’ and needs treatment (traditionally by laser) if there is:

  1. Retinal thickening within one third of a disc diameter from centre of macula
  2. Hard exudates within third disc diameter (if associated with adjacent retinal thickening) of centre of macula
  3. Retinal thickening greater than one disc area in size, part of which is within one disc diameter of the centre of the macula

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  exudates, and ischaemia (covered in more detail later on).

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• Extra ocular muscle palsy
• Retinal vascular occlusions
• Cataract
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  Cataract

  

  Cataract

  Source: eyerounds.org

  Posterior subcapsular cataract is frequently seen in diabetics. In this case the slit lamp beam of light is passed across the lens and the opacity is seen at the back of the resulting cross-sectional view through the lens (arrows). There is also some opacity of the lens nucleus (nuclear sclerosis, centred on the asterix), seen as the central white haze.

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The complications can be reduced by:

• Early detection
• Monitoring
• Good diabetic control
• Modification of risk factors
• Effective treatment