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CP2 Ophthlamology > Gradual visual loss > Flashcards

Gradual visual loss Flashcards

1
Q

What is a cataract?

A

Vision impairing disease characterised by gradual, progressive loss of transparency of the lens

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2
Q

What are the 4 stages of development of a cataracts?

A

1) Immature cataracts
2) Mature cataract
3) Hypermature cataract
4) Morgangnian cataract

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3
Q

What is an immature cataract

A

Lens partially opaque

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4
Q

What is a mature cataract

A

Anterior cortical changes sufficiently dense to obsccure the view of post lens

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5
Q

What is a hypermature cataract

A

Lens shrunken, lens capsule = wrinkled b/c leakage H2O

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6
Q

What is Morgagnian cataract?

A

Hypermature - total liquefaction of cortex

Nucleus sinks inferiorly

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7
Q

Clinical features of cataracts (5)

A 
Decreased visual acuity 
Glare 
Myopic shift 
Monocular diplopia 
'Blurry/misty vision'
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8
Q

Which type of cataracts are the majority?

A

Age-related cataracts

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9
Q

By 75, what % have lens opacities?

A

75%

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10
Q

By 100, what % have lens opacities?

A

100%

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11
Q

Factors causing cataracts (7)

A 
Allergy 
HoTN
HTN 
Mental retardation 
UV light 
IR radiation 
DM
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12
Q

What % congenital cataracts is inherited?

A

33%

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13
Q

When does juvenile cataracts develop?

A

During first 12 years of life

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14
Q

Appearance of juvenile cataarcts?

A

Snow-flake opacities in ant + post subcapsular location

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15
Q

Appearance of blunt trauma cataracts

A

Rosette-shaped appearance + PSC

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16
Q

Appearance of penetrating trauma cataracts

A

Whole lens may become cataractous if large

If small - localised @ site penetration

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17
Q

Causes of traumatic cataracts (3)

A

Glass blowers
Electric shock
IR

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18
Q

What is a true diabetic cataract?

A

Osmotic overhydration of lens –> post/ant lens opacities

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19
Q

Appearance of galactosaemia cataract

A

Oil droplet appearance

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20
Q

Appearance of galactokinase deficiency cataract

A

Lamellar opacities

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21
Q

Which drugs can cause PSC?

A

Corticosteroids

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22
Q

What can chlorpromazine cause?

A

Yellow deposits

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23
Q

Causes of high myopia

A

Glacuomfleken

Post-surgical

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24
Q

Appearance of atopic dermatitis cataracts

A

Fibrotic anterior subcapsular cataract

25
Q

Appearance of myotonic dystrophy cataracts

A

Christmas tree appaerance

26
Q

Apperance of Marfans cataracts

A

Ectopia lentis - lens displacement

27
Q

Where is a PSC?

A

In front of posterior capsule

28
Q

Appearance PSC?

A

Vacuolated/plaque like appearance

29
Q

What is PSC associated with?

A

Steroid use

DM

30
Q

What do people with PSC have issues with?

A

Bright sunlight/oncoming headlights

31
Q

In PSC, is reading or distance vision better

A

distance vision

32
Q

Where is a nuclear sclerotic cataract?

A

In lens nucleus

33
Q

Nuclear sclerotic cataract appearance

A 
Yellwish hue (early) 
--> brownish discoloration
34
Q

What is Nuclear sclerotic cataract associated with?

A

Smoking
Calcitonin
Low milk intake

35
Q

In NSC is reading or distance vision better?

A

Near vision

36
Q

Appearance cortical cataracts

A

Starts as clefts/vacuoles in cortex between lens + fibres

–> opacification –> radial spoke like opacities

37
Q

What are cortical cataracts associated with?

A

Enviro stressers; UV, DM, Dx ingestion, old age

38
Q

When should you Tx a congenital cataracts if <2y/o?

A

Immediately

39
Q

When should you Tx a congenital cataracts if 2-7y/o

A

within 1 week

40
Q

Types of partial congenital cataracts (3)

A

Either planar, zonular or membranaceous

41
Q

Types of zonular congenital cataracts (4)

A

Lamellar, stellate, sutural or nuclear

42
Q

If vision is obstructed in congenital cataracts, what must be done and why?

A

Extraction within days/weeks

Prevent irreversible amblyopia

43
Q

Differential diagnosis cataracts (3)

A

Macular degeneration
Presbyopia
Retinal disease

44
Q

2 investigations required for diagnosis cataracts

A

Hx

Slit lamp exam for corneal intergrity/endothelial layer

45
Q

When would you use a B-scan USS in cataracts

A

When fundus = obscured by dense cataract to rule out posterior segment disease

46
Q

What can be used to predict post-op morbidities in cataracts

A

Pachymetry + specular microscopy

47
Q

What factors should be considered before cataract surgery?

A 
Degree disability 
Pt opinion 
Best correct visual acuity 
General health 
Coexisting ocular pathology 
Age
48
Q

What is ICCE?

A

Intracapsular cataract extraction

49
Q

When is ICCE used?

A

When zonular integrity = severely impaired

50
Q

What is ECCE?

A

Removal lens nucleus through ant ccapsule opening

Post capsule integrity retained

51
Q

What is PE?

A

Phacoemulsification
Extraction of lens nucleus through ant capsule opening
Irrigation + aspiration cortical material
IOL into post capsular bag

52
Q

What is beneneficial about PE?

A

Smaller incisions means more rapid wound healing + better control IOP

53
Q

Intraoperative complications cataracts

A

Capsular tear

Haemorrhage

54
Q

Complications - when does retinal detachment usually occur?

A

Within 6 months

55
Q

Complications - when does acute endophthalmitis usually occur?

A

Within 2-5 days

56
Q

Features acute endophthalmitis?

A 
Marked visual loss 
Pain 
Poor red reflex 
Educate 
Hypopyon
57
Q

Tx acute endophthalmitis?

A

ABx

58
Q

Within 3 years of cataracts surgery, what % –? post-capsular opacification?

A

10-50%

59
Q

Tx post-capsular opacification?

A

Nd/YAG laser

CP2 Ophthlamology (11 decks)

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