Unit 10: Systemic Disease

Presentations

Ocular manifestations of diabetes:

Diabetic retinopathy

Diabetic Retinopathy

Diabetic retinopathy

Source: Adapted from an image uploaded to retinagallery.com by Steven Cohen.

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).
Diabetic maculopathy
Diabetic Maculopathy
Diabetic Maculopathy

Source: Adapted from an image uploaded to retinagallery.com by Steven Cohen.
Diabetic maculopathy refers to abnormalities involving the macular, most commonly macular oedema,

Macular Oedema

Macular Oedema

Source: Adapted from an image uploaded to 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:

Retinal thickening within one third of a disc diameter from centre of macula

Hard exudates within third disc diameter (if associated with adjacent retinal thickening) of centre of macula

Retinal thickening greater than one disc area in size, part of which is within one disc diameter of the centre of the macula

exudates, and ischaemia (covered in more detail later on).
Extra ocular muscle palsy
Retinal vascular occlusions
Cataract

Cataract

Cataract

Source: EyeRounds.org. Contributor: Andrew Doan, MD, PhD, University of Iowa.

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.

The complications can be reduced by:

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

1: Diabetic Retinopathy

Presentations