Question

An elderly woman presented with gradual painless diminution of vision. The fundus picture is shown below. What is the diagnosis.

• A. Hard Exudates in Diabetic Retinopathy
• B. Flame shaped haemorrhages in Hypertensive Retinopathy
• C. Soft Exudates in Hypertensive Retinopathy
• D. CRVO

Answer 1

The Correct Option is A

The clinical scenario describes an elderly woman with gradual painless diminution of vision. The specific appearance of the fundus in the associated image is key to lead us to the correct diagnosis.

The options provided are different retinal findings associated with systemic conditions:

• Hard Exudates in Diabetic Retinopathy
• Flame shaped haemorrhages in Hypertensive Retinopathy
• Soft Exudates in Hypertensive Retinopathy
• CRVO (Central Retinal Vein Occlusion)

Let's analyze the options:

Hard Exudates in Diabetic Retinopathy: These are lipid deposits in the retina appearing as yellow-white spots with distinct edges. They commonly occur in patients with diabetes due to chronic hyperglycemia affecting the retinal blood vessels. The patient's gradual and painless vision decrease aligns with the presentation of diabetic changes in the retina.

Flame shaped haemorrhages in Hypertensive Retinopathy: These appear as hemorrhages following the nerve fiber layer texture, typically seen in hypertensive patients. The question specifically mentions exudates, not hemorrhages.

Soft Exudates in Hypertensive Retinopathy: Also known as cotton wool spots, these result from microinfarctions in the nerve fiber layer. Although seen in hypertension, cotton wool spots differ from hard exudates in appearance and are typically fluffy and less defined.

CRVO (Central Retinal Vein Occlusion): This condition usually presents with marked vision loss and retinal hemorrhages, known as "blood and thunder" appearance, distinct from exudates.

Given the presentation and options, the gradual painless diminution of vision and presence of characteristic fundal lesions indicate Hard Exudates in Diabetic Retinopathy as the correct diagnosis.