Gradual loss of vision Flashcards
causes of gradual visual loss (8)
cataracts diabetic retinopathy glaucoma HTN slow retinal detachment macular degeneration optic atrophy retinitis pigmentosa
Choroiditis definition and causes (5)
infection that can>granulomatous reaction caused by:
- toxoplasmosis
- toxocara
- TB
- sarcoidosis
presentation of choroiditis (4)
floating black spots
pain/redness
blurring of vision
photophobia
Ix in choroiditis (3)
CXR
Mantoux (tuberculin)
serology
Fundoscopy in choroiditis (4)
raised white-grey patch
choroidal opacities
white cells in anterior chamber
later, choroido-retinal scars form which appear as white patches and are asymptomatic unless they affect the macula
epidemiology, fundoscopy and complication of choroid melanomas
most common ocular malignancy
fundoscopy shows mottled grey/black patch
there is retinal detachment over the melanoma
Rx of choroid melanomas (5)
enucleation plaque/local radiotherapy photocoagulation trans-pupillary thermotherapy micro-surgical resection
RFs for age-related macular degeneration (7)
hypermetropia female caucasian blue eyes low B12 high cumulative light exposure genesd
Features of macula in ARMD (5)
pigment drusen-fatty deposits optic disc is irregular, lumpy and yellow absent optic cup sometimes there is bleeding
Features of dry(non-neovascular) ARMD (3)
90% of ARMD
mainly drusen and degenerative changes at macula
slow progression
Fundoscopy of wet ARMD (3)
retinal pigment epithelium thickens
drusen develops
new choroidal vessels grow from choroid>neurosensory retina and cause leakage of blood.
key clinical features of wet ARMD (2)
rapid deterioration of CENTRAL vision-may only take a few wks.
distorted vision
Ix or wet ARMD (2)
fundoscopy shows fluid exudation and localised detachment of pigment
fluorescin angiography allows visualisation of the extent of neovascularisation
Rx of wet ARMD
regular monitoring w. fluorescin angiography
intravitreal anti-VEGF: bevacizumab/ranalizumab
photocoagulation
intravitreal steroids as an adjunct-triamcinolone
Other measures in wet ARMD (3)
screening once signs have been identified e.g. Amsler grid
visual aids
diet:leafy green vegetables, omega 3, zinc, vit B+C+E, beta carotene(avoid in smokers), lutein
Presentation, aetiology, fundoscopy and Rx of Stargardt macular degeneration (4)
gradual visual loss in teenagers
assoc. w. many genetic mutations.
fundoscopy shows prominent yellow flecks
Rx w. embyronic stem cells
Pathogenesis and features of tobacco-alcohol amblyopia (4)
cyanide radicals from combined smoking and alcohol excess lead to optical atrophy, loss of red-green discrimination and scotoma.
Categories of cataracts (5)
immature-red reflex still present
dense-no red reflex+unable to visualise fundus
nuclear sclerotic-change in refractive index w. age
anterior/posterior polar cataracts-localised, commonly inherited and lie in visual axis
subcapsular opacities (e.g. from steroids) are just deep to the lens capsule
RFs for cataracts (13)
age/UV exposure hypocalcaemia turner's galactosaemia steroid use infection-congenital rubella dystrophia myotonica (cataracts, male pattern baldness, heart block and locking muscles) DM chronic anterior uveitis down's irradation touching lens during surgery high myopia
Presentation of cataracts (5)
blurred vision frequent change in specs prescription dazzle monocular diplopia vision may improve w. pinholing
fundoscopy and important Ix at Dx of cataracts
black dot in middle of red reflex>cataract obscuring path of light to the retina
do fasting blood glucose at Dx
surgical Mx of catarcts including pre and post-op (6)
pre: ocular biometry to measure curvature of cornea and length of eye
during:
- phacoemulsion: break down and aspirate lens
- insert prosthetic lens
post:
- may have Sx of imbalance
- lens can’t accomodate => new reading glasses needed
- anti-inflammatory eye drops and Abx needed for 4-6wks
complications of cataracts surgery (6)
lens thickening irritation astigmatism becomes more noticeable anterior uveitis intra-ocular lens dislocation rarely:vitreous haemorrhage, glaucoma and endopthalmitis
Features of intra-ocular lens dislocation (6)
decreased vision diplopia halos in vision streaks of light in vision lens glare photosensitivity
