# Retinopathy - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Diabetic Retinopathy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK560805/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD67 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Retinopathy - disease-level clinical article (retinopathy-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text RETINOPATHY Sources: Diabetic Retinopathy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK560805/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD67 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Retinopathy - disease-level clinical article (retinopathy- clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Early disease can be silent, sometimes only picked up incidentally on a fundus exam. - As it progresses, blurred or distorted vision, floaters, and partial to complete vision loss can develop. [floaters] - What drives it worse: poor sugar control, uncontrolled blood pressure, abnormal lipids, kidney disease, male sex and obesity [obesity] - Red flag: it is the leading cause of severe sight loss in adults of working age [loss of vision] SIGNS - what you find (8) - Microaneurysms are the earliest lesion an exam can pick up, though ones under about 30 micrometers may be too small to see clinically. - The smallest microaneurysms, under roughly 30 micrometers across, may not be visible on clinical exam. - Small hemorrhages within the retina come from ruptured weak capillary walls, with superficial flame-shaped bleeds arising from a different, more superficial vessel layer. [bleeding] - Hard exudates - lipid deposits - typically form a ring around a leaking microaneurysm. - Cotton wool spots represent tiny infarcts of the small precapillary blood vessels. - Retinal veins can show dilation, looping, beading, or a sausage-like segmented appearance on exam. - New vessels growing on the iris signal a poor prognosis and a tendency toward neovascular glaucoma. - Severe non-proliferative disease is defined by severe hemorrhages across all four retinal quadrants, venous beading in at least two quadrants, or marked IRMA in at least one quadrant. TESTS (8) - A fasting glucose of 126 mg/dL or higher on two separate occasions confirms diabetes, versus 110 to 125 for prediabetes. - HbA1c should be kept under 7 percent, with a normal range of roughly 4 to 5.6 percent. - A complete ocular workup includes visual acuity, eye pressure, gonioscopy to check for iris neovascularization, slit-lamp exam, and a dilated fundus exam to grade the retinopathy. - Fluorescein angiography can pin down ischemic maculopathy, map areas where capillaries have dropped out, tell IRMA apart from true new vessels, and reveal occult neovascularization not seen on exam. - OCT of the macula measures retinal thickening, tracks how edema responds to treatment, and can diagnose traction or a membrane that might need surgery. - B-scan ultrasound is valuable when the view is hazy, checking for vitreous hemorrhage, tractional detachment, or posterior vitreous detachment. - OCT angiography maps blood flow in the retina without an injected dye, similar to fluorescein angiography. - Caught early and treated promptly, most patients keep useful vision IF NOT THIS - what else fits (4) - Hypertensive retinopathy and central or branch retinal vein occlusion are part of the differential for the macular edema seen here. - A ruptured microaneurysm or macular edema from an epiretinal membrane can also produce a similar picture. - A retinal macroaneurysm or thalassemia-related retinopathy can likewise be mistaken for it on general fundus appearance. - Uncontrolled diabetes damages the eye in other ways too, so think of cataract, glaucoma, a dry surface, recurrent stye, ischaemic optic neuropathy and diabetic papillopathy Source StatPearls "Diabetic Retinopathy" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult General term for retinal damage; in Egypt the dominant drivers are diabetic and hypertensive retinal disease, both very common given local diabetes and hypertension rates. A GP's role is optimising the underlying disease (already covered under those separate conditions) and referring promptly to ophthalmology for retina-specific treatment such as laser or intravitreal therapy, which a GP does not prescribe. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why General term for retinal damage; in Egypt the dominant drivers are diabetic and hypertensive retinal disease, both very common given local diabetes and hypertension rates. A GP's role is optimising the underlying disease (already covered under those separate conditions) and referring promptly to ophthalmology for retina-specific treatment such as laser or intravitreal therapy, which a GP does not prescribe. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Delay in proper follow-up and evaluation can lead to permanent, irreversible vision loss. RED FLAG - Sudden vision loss, new floaters or flashes suggesting retinal detachment, or rapid vision decline in a known diabetic or hypertensive patient. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)