A 60yr old man has both HTN and DM for 10 years. There is reduced vision in one eye. On fundus examination there is a central bleed and the fellow eye is normal. The diagnosis is:
B i.e. Retinal tear There is confusion b/w DR, HTNR & retinal tear only. Although normally retinal tears are usually peripheral and typically occur in equatorial and ora serrata regions of retina. In diabetic patients, retinal breaks are usually in the posterior pole near areas of fibrovascular change. The tears are oval and result from tangential traction from proliferative tissue and vitreous. In diabetics, retinal detachment (RD) may be rhegmatogenous (d/t retinal break formation) and nonrhegmatogenos (caused by traction alone). When RD is rhegmatogenous, the borders of elevated retina usually extend to the ora serrata. The retinal surface is dull & grayish and undulates b/o retinal mobility d/t shifting of subretinal fluid. Oval breaks are usually present in the posterior pole. Whereas in non rhegmatogenous (traction) RD, the detached retina is concave toward the pupil with taut and shiny surface. It is usually confined to the posterior fundus and infrequently extends more than 2/3rd of the distance to the equator. No shifting of subretinal fluid occurs. Diabetic retinopathy is usually and hypeensive retinopathy is invariably bilateral. (Kanski-567). So asymmetric involvement (normal fellow eye) almost rules out both. But diabetic vitreous haemorrhage occur during sleep, possibly b/o increase in BP secondary to early morning hypoglycemia.
Diabetic retinopathy
Retinal tear
Optic neuritis
All