Trans 007 Aging Eye And Systemic Diseases Flashcards
• Opacification of human crystalline lens The most common problem when a person ages Anybody can have cataract
Cataract
Anterior versus posterior subscapular cataract
Ant-Lies directly under the lens capsule
Post -Lies in front of the posterior capsule
Typically appears black and vacuolated on retroillumination anterior/posterior subscapular cataract?
Posterior
Cataract that involves the nucleus of the lens
o
Yellow to brown coloration Usually in the medial part of the lens
Nuclear cataract
Associated with myopia due to an increase in the refractive index of the nucleus, resulting in some elderly patients being able to read without spectacles again (‘second sight of the aged’)
Yellowish hue due to the deposition of urochrome pigment, best assessed with an oblique slit lamp When advanced, nucleus may appear brown, or even black (typical of marked post-vitrectomy opacity)
What cataract?
Nuclear cataract
Wedge-shaped or radial spoke-like opacities Opacities are usually in the periphery of the lens Located in the cortical part, not the nuclear part Only seen when you dilate the pupils Glare is a common symptom
Cortical cataract
Opacity is in the posterior pole of the lens
Polar cataract
Not yet fully opacified Red-orange reflex can still be seen through ophthalmoscope
What classification of cataract
immature cataract
Red-orange reflex cannot be seen
Opacity has reached the stage where most of the ophthalmoscope lights cannot reflect anymore
What classification of cataract
Mature cataract
What classification of cataract
Usually wrinkled appearance of capsule
Hyper-mature cataract and there is Thinning of lens
More mature than hypermature Lens shrinks Lens will be smaller than capsule. Parang wala nang laman
Morgagnian cataract
o Denaturation and coagulation of lens proteins o Decrease level of amino acids and protein synthesis o Increased hydration brought by decrease in potassium due to reversal of Na’K pump mechanism
This is path physiology of what cataract?
Cortical cataract
o Degenerative changes occurring as nuclear sclerosis o Increase in water insoluble proteins o Compaction of nucleus resulting in a hard cataract o Disturbance of lamellar arrangement in fibers
This is pathophysiology of what cataract
Nuclear cataract
- Painless progressive visual loss
- Glare Earliest to be detected by the patient Complaint especially when driving and there’s oncoming light Diff dx: Error of refraction
- Reduced color perception
- Color haloes
- Uniocular diplopia Usually described by the patient as doble parin yung paningin kahit na nakatakip na yung isang mata
- Based on the location and density
What cataract
Age related (senile) cataract
Some of the signs of senile cataract
- Opacification of the normally clear lens senn through the pupil
- Indistinct on retina examination
- Red reflex may be dim
- No afferent pupillary defect
- Myopic shift
Most common surgery done in ophthalmology
Cataract extraction with intra-ocular lens implantation
Treatment of cataract
• Refraction and corrective eyeglasses Consider this first before proceeding to surgery
• Surgical
o Cataract extraction with intra-ocular lens implantation If there is difficulty in life even if all other solutions have been tried, then consider surgery Most common surgery done in ophthalmology Some patients have cataract surgery even at 80 years old When doing surgery, don’t look at the age. Look at the quality of life of the patient.
Result of increased intraocular pressure (IOP) caused by a malformation or malfunction of the eyes drainage system
Increased pressure causes compression of retina and the optic nerve
Causes progressive, permanent loss of eyesight if left untreated
Glaucoma
Normal IOP is
19-21 inches of mercury
Normal drainage system of the eye becomes partially blocked, causing pressure to build within eye
o Usually affects the perimitery vision first, with sight gradually being lost towards the center of the eye
What glaucoma
Primary Open Angle Glaucoma (POAG)
Symptom
Of primary open angle glaucoma
o No symptoms in early stages
o Mild pain in the eye, increasing gradually over time
o “Halos” appearing around lights
o Gradual loss of peripheral vision o Loss of night vision
People at risk in primary open angle glaucoma
People at risk o Family history of glaucoma o African-americans o Px suffering from Myopia o Patients suffering from Diabetes o >35 years of age
