Diabetes 1 Flashcards
Who is most likely to get diabetes
south asian
obese
rough figures of UK- 3.9%- 2.5million people
What is Diabetic retinopathy
A diabetic microangiopathy affecting retinal blood vessels
due to poor metabolic control. could lead to progressive retinal damage -complete visual loss????
Who does diabetic retinopathy effect?
Both type 1 and type 2.
Highest among young px with type 1
However more px have type2- therefore more px with DR and type 2
not as common if secondary diabetes
common cause of blindness in working population
What are the risk factors for diabetic retinopathy
poor metabolic control hypertension? longer duration of the disease type 1 diabetes- all px develop some after 10-15 years LDL choloseterol pregnancy aneamia smoking???
What can Microangiopathy- Capillary Occlusion lead to?
a- Microvascular occlusion- Cotton wool spots, neovas, arteriovenous shunts, capillary closure
b- Microvascular leakage- exudates, odeama, haemorrhages
What are micro aneurysms
Small red dots- 20-200um
The earliest detectable change in DR
What can happen with micro aneurysms
They can self resolve- half disappear within 3 years rupture- hemmorages occlude- infarction- cotton wool spots leak- exudates/odeama
What are exudates
Yellow waxy layeres
Between inner plexiform and inner nucleus layers
due to leakage of lipoproteins from the capillaries
What are haemorrhages
Bleed
- Dot and blot haemorrhages from the venous end of the capillaries- and in compact middle layers.
- Flame shaped haemorrhages originate from superficial pre capillary arterioles and follow the NFL
Whats background retinopathy
Early changes associated with DR-
not on macular- non sight threatening
u may see a few micro-aneurysms, haemorrhages, exudates and cotton wool spots.
Whats maculopathy
Leakage of retinal fluid around the fovea.
sight threatening complication
can also see micro-aneurysms/exudates/hemamohrages
What are the types of maculopathy
Focal- due to focal leakage from micro-aneurysms and capillaries
Diffuse- leakage from capillaries around the posterior pole- can cause diffuse macular odeama- difficult to treat as diffuse
Ischeamic- hypo perfusion of macular- decreased blood flow
What’s a cotton wool spot
Retinal micro infarcts as a consequence of retinal ischeamia
Whats pre- proliferative retinopathy?
From retinal ischaemia
more than 5 cotton wool spots
sight threatening
venous irregularities- beeding, duplication and loops
heamorages
intre-retinal microvascular abnormalities
What does venous beading show
retinal ischeamia
INTRA RETINAL MICROVASCULAR ABNORMALITIeS
IRMA- AV shunts
What’s prolifertaive retinopathy
From retinal hypoperfusion
Sight thearening
neovasculirsation- could get new blood vessels on disc NVD and NVE new blood vessels elsewhere
pre retinal or subhyloid heammohrages- looks like a boat- louis style
fibrous tissue
Advanced diabetic eye disease
Sight is compromised vitreous heammorage fibrous tissue rd? rubeosis iridis- new blood vessels on iris neovascular glaucoma
Catracts and diabetes.
Develops at an earlier age
quite common
And faster if diabetes is uncontrolled
the osmotic lens opacity is reversible
and if needs be- can’t see fundus- lots of light scatter during laser therapy-
then cataract surgery- u need optimal diabetes control- STABLE DIABETES
More complications- difficult due to smaller pupils? also iritis, raised iop, delayed wound healing
POst operative care for diabetic cataracts
inflammation more likely
DR may detorriate due to surgery- particularly macular odeama
px need to be seen day after op
post eye drops? steroids/ anti inflammatory
With diabetes what happens to the iris?
Iris transillumination? loss of pigment behind iris- can see cells in ac. not serious but shows lack of control of diabetes
Iris rubeosis- new vessel growth into iris and AC angle- due to ischeamia- could cause neovas glaucoma as BV can occlude TM
can treat with pan-laser and
use anti vegf drugs
Diabetes and cornea
Minor probs diaebtic keratopathy Contraindication of cl wear loss of sensitivity- increased chance of corneal erosions/ ulcers more fragile epithelium
Diabetic conjuctiva
can see microaneuryms- usually harmless- warning at risk of DR
Cranial 3rd nerve palises and diabetes
3rd nerve palsy caused by microangiography pupil dilation limited movement may have ptosis however with diabetes-may be partial- i.e. pupil not always involved recovers within 6 months
IF PAINFUL- REFER URGENT- as could be intracranial aneurysm
Diabetes and 6th nerve palsy
cannot abduct
Management of diplopia
path prisms see an orthoptist refer to hosp if secondary to diabetes- revers well within 6months
Mucormycosis of Orbit-
fatal fungal infection
gets through nose
for type 1 young px
