Gradual Visual Loss Flashcards
cataracts importance/stats
#1 cause of blindness increases with age (100% 100yo)
RF: age, UV, smoking, alcohol, CST, DM, renal, radiation, Down’s, myotonic dystrophy
types of cataracts
fibrotic: total; atopy; age-related/subcapsular nuclear sclerotic cortical: radial spokes blue dot: congenital snowflake: DM osmotic hydration traumatic: iris torn metabolic: galacotsaemia, wilson's other: uveitis, high myopia, steroids, chlorpromazine (yellow) systemic: myotonic dystrophy (Xmas tree), Marfan's, NF2
classification/aetiology
anatomical:
posterior subcapsular (PSC): vacuolated; DM/steroids
cortocal: radial spokes; UV, DM, drugs
nuclear: yellow/brown, distance > near;
aetiological: age-related congenital traumatic: iris/lens damage metaolic toxic secondary systemic disease maternal infection
developmental:
immature
mature: completely opaque cortex
hypermature: small, wrinkled, leaky
phaco detail
corneal incision, maintain pressure, anti-scar peel off anterior capsule US high frequency probe to fragmaent aspirate and replace after irrigation close edges of flap
differentials for GLoV
corneal dystrophy, ectasia (detail)
lens: cataract
macula: AMD, dystrophy, DM/CSMO
optic disc: compression, toxins
retina/choroid: RP (spicules, nyctalopia, optic atrophy, ring scotoma)
other: choroidal melanoma, stargardt, tobacco-alcohol amblyopia (CN)
age-related and congenital
age: commonest; multifactorial (allergy, BP, LD, UV, infrared, DM)
anterior or posterior, bright lights,
posterior: near > far; DM/steroids
congenital: 33% inherited; present at birth; variable; amblyopia risk
traumatic
rosette-shaped lens damage penetrating eye injury: direct damage blunt injury: pigment onto lens (Vossius ring) Glass blower's (infrar red); anterior shock; ionising radiations
metabolic
DM: age-related earlier,; true juvenile (snowflake); true DM (osmotic hydration; snowflake capsules)
galactosaemia: oil-drop
Wilson’s: red/brown sunflower
hypocalcaemia, Fabry’s, mannosidosis
toxic
CST: posterior subcapsular, esp with CST
chlorpromazine: fine yellow spots, anterior capsule
chemotherapy (busulphan)
secondary
uveitis hereditary retinal generation e.g. RP high myopia glaucomflecken (grey/white specks), anterior sucap, PACG ciliary malignant melanoma: sectoral post-op glaucoma: posterior subcapsular
systemic disease
cutaneous: atopic eczema (posterior stellate/anterior shield/fibrosis)
CTD: Marfan’s, mm dystrophy (xmas tree)
CNS: NF2
Down’s/Alport’s syndrome
maternal infection
rubella: 50% cataracts toxoplasmosis, CMV thalidomide CMV
clinical features
change in vision: VA, contrast, yellow/brown tint, glare, ghosting, monocular/diplopia
change in fundus: diffult view
change in refraction: myopic shift, astigmatism
investigations
history + slit lamp
comorbidities
ocular B scan USS: rule out posterior pole pathology/posterior segment
refraction + biometry for IOL: axial length (A-scan), corneal diopters (keratometry), anterior chamber depth corneal integrity (post-op risk e.g. oedema) *leave myopic: near vision
management
assessment: disability, experience, VA, ocular pathology, general health, age, development stage, biometry
no medical; can try lenses surgery: phacoemulsification intracapsular cataract extraction (ICCE) ECCE
