Fundoscopy: characteristic findings (CN II)

For whatever reason, the College had used some fundoscopy images in Question 15.3 from the second paper of 2012. Some familiarity with these is therefore required, even though the author can safely confess that he has not performed a single clinically useful fundoscopy in the course of his ICU career, nor ever seen any of his seniors perform it, not heard it referred to in any terms other than "get the ophthalmology guys to check for Candida".

Fundoscopy Findings and their Pathophysiological Associations

Retinal haemorrhage


  • Malignant hypertension
  • Endocarditis
  • Pernicious anemia
  • Leukaemia
  • Subarachnoid hemorrhage
  • DIC



  • Elevated intracranial pressure
    • The absence of papilledema does not mean that all is well, since its development does not occur immediately after intracranial pressure rises.
  • Visible retinal venous pulsations exclude increased intracranial pressure.
  • Absent pulsations do not necessarily mean elevated intracranial pressure.

Cotton wool spots

Features of malignant hypertension

  • Optic disk swelling, with blurred margins
  • Retinal haemorrhages
  • Cotton wool spots
  • Cotton wool spots are pale areas of infarction




The Stanford School of Medicine has an excellent resource on fundoscopy.

So does Walker's Clinical Methods (3rd ed, 1990) - the chapter on fundoscopy is particularly good for pathophysiological correlations.

Hayreh, Sohan Singh, et al. "Fundus lesions in malignant hypertension."Ophthalmology 93.1 (1986): 45-59.