Gradual loss of vision Flashcards
What is a cataract?
Lens of the eye becomes cloudy and opaque
What are the risk factors for a cataract?
- Age
- Smoking
- UV radiation
- Hyperglycaemia
- Steroids
- Hypocalcaemia
What conditions are associated with cataracts?
- DM
- Metabolic disorders (galactosaemia, hypocalcaemia, Fabry disease)
- Myotonic dystrophy
- Atopic dermatitis
- Systemic syndromes (Down’s, Lowe’s)
What are the symptoms of a cataract?
- Painless, slow loss of vision
- Blurring of vision
- Colours becoming more brown/yellow
- Starbursts around lights, especially at night
- Glare
- Change in refraction
How do you diagnose a cataract?
- Fundoscopy
o Cataract appears black against the red reflex - Slit-lamp
What is glaucoma?
Damage to the optic nerve due to raised IOP
What is open angle glaucoma?
Increased resistance through trabecular meshwork
What are the symptoms of open angle glaucoma?
- Painless loss of vision
- Tunnel vision
- Halos at night
- Headaches
What are the risk factors for open angle glaucoma?
- Family Hx
- Having a thin cornea
- Race – afro-Caribbean
- DM
- Old age
- Being short-sighted (myopia)
How do you diagnose open angle glaucoma?
Tonometry
- >21mmHg
Slit-lamp
- Cup-to-disc ratio >0.7
What is the management for open angle glaucoma?
- Lantoprost (prostaglanin analogue drops)
- Laser
- Surgery
What is closed angle glaucoma?
Iris bulges forwards and seals off trabecular meshwork from the anterior chamber, preventing aqueous humour from draining
What are the symptoms of closed angle glaucoma?
- Painful loss of vision
- Halos around lights
- Watery eye
- Systemic symptoms
What are the risk factors for closed angle glaucoma?
- Age
- Females>males
- Family Hx
- Chinese and East Asian
- Shallow anterior chamber
- Hypermetropia
- Adrenergic medications: noradrenalin
- Anticholinergic medications: oxybutynin
- Tricyclic antidepressants: amitriptyline
How do you diagnose closed angle glaucoma?
- > 21mmHg
- Cup-to-disc ratio >0.7
- Tender and hard eye
- Cloudy cornea
- Mild-dilated unreactive pupil
What is the management of closed angle glaucoma?
- Pilocarpine
- Acetazolamide
- Analgesia
- Antiemetic
What are the symptoms of dry ARMD?
- Difficulty with reading, fine detail, seeing faces clearly
- Flickering or flashing lights
- Scotoma
- Gradual loss of central vision (peripheral vision is sparred)
What are the symptoms of wet ARMD?
- Difficulty with reading, fine detail, seeing faces clearly
- Flickering or flashing lights
- Scotoma
- Rapid loss of vision
- Demarcated red patches
What are the risk factors for ARMD?
- Female gender
- Smoking
- HTN
- Previous cataract surgery
- Family Hx
How do you diagnose dry ARMD?
- Visual acuity - May be reduced
- A black patch affecting the central field of vision (scotoma)
- Amsler grid - straight lines appear wavy
- Fundoscopy - Drusen
How do you diagnose wet ARMD?
- Visual acuity - May be reduced
- A black patch affecting the central field of vision (scotoma)
- Amsler grid - straight lines appear wavy
- Fundoscopy - fluid and/or blood in retina and choroidal neovascularisation
How do you manage dry ARMD?
• High-dose antioxidant vitamins and zinc
How do you manage wet ARMD?
• Anti-VEGF injections
What is diabetic maculopathy?
hard exudates and other ‘background’ changes on macula
What is pre-proliferative diabetic retinopathy?
- cotton wool spots (‘soft exudates’ - represent areas of retinal infarction)
- > 3 blot haemorrhages
- venous beading/looping
- deep/dark cluster haemorrhages
What is proliferative diabetic retinopathy?
retinal neovascularisation
