Eye Flashcards
83 yr old female
Diabetic retinopathy
Intro:
I’m going to begin by looking at the exterior surface of the eye and surrounding structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: There is evidence of neovascularisation at the optic disc, with dot and blot haemorrhages in the superior nasal and inferior temporal arcades and circunate hard exudates following the vascular arcades. Cotton wool spots line the peripheries and
Summary: This appearance is consistent with background proliferative diabetic retinopathy
NOTE: Diabetic vs hypertensive retinopathy- diabetic: dot and blot haemorrhages are frequent cotton wool spots are rare. Flame haemorrhages are rare. Diabetic is wet. Hypertensive is not.
83 yr old female
Advanced proliferative diabetic retinopathy with pre-retinal fibrosis
Intro:
I’m going to begin by looking at the exterior surface of the eye and surrounding structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: There is evidence of circinate preretinal fibrosis around the optic disc.
Summary: This appearance is consistent with advanced proliferative diabetic retinopathy with pre-retinal fibrosis and i would expect the patient to experience metamorphsia if tested using an amsler grid. I would also advise prompt referral to the opthalmology due to the risk of tractional retinal detachment.
NOTE: Diabetic vs hypertensive retinopathy- diabetic: dot and blot haemorrhages are frequent cotton wool spots are rare. Flame haemorrhages are rare. Diabetic is wet. Hypertensive is not.
83 Yr old female
Hypertensive retinopathy with macular star
Intro:
I’m going to begin by looking at the exterior surface of the eye and surrounding structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: There are blurred optic disc markings suggesting oedema. The surrounding blood vessels show AV nicking with silver wiring of the retinal arterioles and there is increased tortuosity. Flame shaped hemorrhages surround the disc margin and there is widespread cotton wool spots and hard exudates encircling the optic disc. The macular star sign is also present. All these changes are more severe in the nasal arcades.
Summary: This appearance is consistent with hypertensive emergency/urgency as there is evidence of optic nerve oedema and swelling which would warrant further investigation. Optic examination would likely show an enlarged blind spot, reduced visual acuity not corrected using pinhole. The patient may complain of N+V. Hypertensive retinopathy can be classified into 4 classes using the Keith-Wagener classification.
NOTE: Diabetic vs hypertensive retinopathy- diabetic: dot and blot haemorrhages are frequent cotton wool spots are rare. Flame haemorrhages are rare. Diabetic is wet. Hypertensive is not.
83 yr old female
Glaucoma
Intro:
I’m going to begin by looking at the exterior surface of the eye and surrounding structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: Optic disc cupping is present with nasal steps and nasal shift of blood vessels and thinning of the retinal nerve fibre layer into the optic disc.
Summary: This apperance is consistent with chronic irreversible open angle glaucoma where the optic cup to disc ratio is greater than 0.5. The patient is likely to be asymmptomatic as central vision is presrved but they may feel pressure in the eyes or have reduced peripheral vision. To assess this further I’d like to refer to assess the drainage angle using gonioscopy and the IOP using tonometry.
83 yr old female
optic atrophy
Intro:
I’m going to begin by looking at the exterior surface of the eye and surrounding structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: The optic disc is pale, flat and white with clearly deliniated borders.
Summary: Consistent with optic atrophy. I would expect the patient to have reduced visual acuity, colour vision and a central scotoma/blind spot. This can be a primary or secondary condition. In the case of optic neuritis the patient may have a painful eye worsened by eye movements.
83 yr old female
Cataracts
Intro: I’m going to start by looking at the external surface of the eye and the surroudnign structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: The red reflex is absent. There is haziness over the cornea obscuring visualisation of the retina.
Summary: this is consistent with cataracts. I would expect the patient to complain of reduced colour intensity and contrast sensitivity as well as reduced visual acuity. There may be a glare that is worse when looking at lights.
83 yr old female
Central retinal vein occlusion
Intro: I’m going to start by looking at the external surface of the eye and the surroudnign structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: flame haemorrhages obscuring the optic disc, macula and nasal and temporal vessels. Bleeding of the retina is present in all four corners. Of what can be visualised, the veins are dilated and tortuous and there are cotton wool spots in the nasal area.
Summary: this is consistent with central retinal vein occlusion. This is an ocular emergency and demands prompt attention?? The patient will have severly reudced visual acuity. While there is no treatment for this condition, it is important to perform fluorscein angiography to assess if the cause is ischaemic or non ischaemic. Underlying conditions can be managed. The density of the RAPD defect corresponds to the degree of ischaemia.
83yr old female
central retinal artery occlusion
Intro: I’m going to start by looking at the external surface of the eye and the surroudnign structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: Cherry red spot with surroudning pale retina
summary: consistent with central central retinal artery occlusion. Poor prognosis due to retinal infarction. Treat as a TIA + HYPERBARIC OXYGEN. Investigate for GCA. In which case methylprednisolone.
83yr old female
Retinal detachment
Intro: I’m going to start by looking at the external surface of the eye and the surroudnign structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: retina is pale, mobile and corrugated folds. a retinal tear or break may be visible or virteous haemorrahge.
summary: this is consistent with retinal detachment. THis is an ocular emergency that demands further treatment. This includes virectomy, scleral buckling or pneumatic retinopexy, or sealing the tear in your retina with laser or cryotherapy.
83yr old female
Macular degeneration
Intro: I’m going to start by looking at the external surface of the eye and the surroudnign structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
Appearance: varies depending on if it is dry or wet. Dry- drusen over the macula. Wet- subretinal haemorrhage, and oedema and drusen.
Summary: this is consistent with wet macular oedema. subretinal haemorrhage, a sign of neovascular AMD . in these patients vision loss is more acute. Treatment includes anti=VEGF injections and pan retinal laser photocoagulation to prevent neovascularisation. On amsler grid there is also evidence of metamorphsia. In dry only treat with vitamins: A,E,C.
83yr old female ?????????
pan retinal laser photocoagulation
Intro: I’m going to start by looking at the external surface of the eye and the surroudnign structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
83yr old female ???????????
posterior vitreous haemorrhage/pre retinal haemorrhage?
Intro: I’m going to start by looking at the external surface of the eye and the surroudnign structures, checking for red reflex for cataracts, corneal arcus, xanthalasma and conjunctiva.
I’m going to then look closer using the opthalmoscope.
Starting at the optic disc, then the superior and inferior temporal and nasal arcades. Then over the macula area and then tracing the peripheries, doing a clockwise sweep to look for peripheral lesions.
Overall: it is grossly abnormal.
