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CP2 Ophthalmology > Gradual Vision Loss > Flashcards

Gradual Vision Loss Flashcards

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1
Q

What is the function of the lens?

What is a cataract

A

Lens function = focus light coming into the eye onto the retina at the back of the eye

Cataract: opacity of the lens. This reduces visual acuity by reducing the light that enters the eye

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2
Q

How does cataract present?

A

Symptoms are usually asymmetrical as both eyes are affected separately:

Very slow reduction in vision
Progressive blurring of vision
Change of colour of vision with colours becoming more brown or yellow
“Starbursts” can appear around lights, particularly at night time

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3
Q

What are the three types of cataracts?

A
  1. Posterior subscapular
  2. Cortical
  3. Nuclear
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4
Q

What is a posterior sub scapular cataract? How do they present?

A

Lies in front of the posterior capsule
Manifest as vacuolated or plaque like appearance

Patients have particular trouble with bright sunligh/oncoming headlight

reading vision affected more than distance vision

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5
Q

What is a cortical cataract?

A

Opacity which starts as cleft and vacuole on the cortex between lens fibres

Radial spoke like opacities

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6
Q

What is a nuclear cataract?

A

Due to nuclear sclerosis characterised by yellowish hue and in later stages, brown discolouration

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7
Q

What are posterior sub scapular cataracts related to?

A

steroid use and DM

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8
Q

What are cortical cataracts related to?

A

environmental stresses: UV exposure, diabetes, drug ingestion

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9
Q

What are nuclear cataracts related to?

A

smoking, calcitonin, milk intake

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10
Q

What are the causes of cataracts?

A
  1. Age-related
  2. Congenital
  3. Trauma
  4. Metabolic - diabetes
  5. drugs: smoking, alcohol, steroids
  6. Associated with primary ocular conditions
  7. hypocalcaemia
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11
Q

What is the majority cause of cataracts?

A

Age-related cataract

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12
Q

What exacerbates age-related cataracts?

A 
allergy
hyper/hypotension 
Mental retardation
UV light 
Infrared radiation
diabetes
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13
Q

What kind of cataracts are age related cataracts?

A

Subscapular

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14
Q

What kind of vision problems do age related cataracts pose?

A

Decreased visual acuity
Myopic shift

GLARES OR HALOS around bright lights

(e.g. oncoming headlights at night)

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15
Q

What proportion of congenital cataracts are inherited?

A

1/3

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16
Q

Describe the morphology of congenital cataracts

A

TOTAL

PARTIAL:
polar - anterior or posterior
zonular - lamellar, stellate, sutural or nuclear
membranaceous

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17
Q

What is the cause of traumatic cataract?

Study These Flashcards
A

Trauma to the lens - iris torn away from normal insertion: shrinking and damage

Blunt trauma - rosette shape appearance

Penetrating trauma -

18
Q

What causes metabolic cataracts?

Study These Flashcards
A

DIABETES - age related or TRUE diabetic cataract (snowflake opacity)

GALACTOSAEMIA - due to GPUT deficiency - presents with oil droplet cataract

GALACTOKINASE deficiency - associated with lamellar opacities

19
Q

What is the cause of toxic cataract?

Study These Flashcards
A

Corticosteroids - PSC
Chlorpromazine - fine yellow deposits anterior lens capsule
Chemotherapy

20
Q

What is the cause of cataracts associated with primary ocular conditions?

Study These Flashcards
A
  1. Uveitis - anterior, CMV, toxoplasmosis, rubella
  2. Hereditary retinal degenerations - retinitis pigmentosa, Gyrate atrophy
  3. High myopia
  4. Post surgical
21
Q

What systemic diseases can cause cataracts?

Study These Flashcards
A
  1. cutaneous: congenital ectodermal dysplasia, Werner’s and Rothmund-Thomson’s, atopic dermatitis
  2. Connective tissue/skeeltal - MD, Conradi’s, stickler’s, Marfan’s
  3. CNS: Marinesco-Sjorgren’s
  4. Down’s
22
Q

What are the clinical features of cataracts?

Study These Flashcards
A

DECREASED VISUAL ACUITY - patient with age-related cataract often presents with a history of gradual progressive deterioration and disturbance in vision

GLARE/HALOS - decrease in contrast sensitivity in brightly lit environments, or oncoming traffic

MYOPIC shift - mild-moderate myopia.

MONOCULAR DIPLOPIA - - double vision in one eye

LOSS OF RED REFLEX: The lens can appear grey or white when testing the red reflex. This might show up on photographs taken with a flash

23
Q

What Investigations are done for cataracts?

Study These Flashcards
A

HX + slit lamp - loss of red reflex

LAB tests:

OCULAR B SCAN ULTRASONOGRAPHY

REFRACTION

BIOMETRY

CORNEAL INTEGRITY (endothelial layer)

24
Q

What is the management for cataracts?

Study These Flashcards
A

If the symptoms are manageable then no intervention may be necessary.

Cataract surgery involves drilling and breaking the lens into pieces, removing the pieces and then implanting an artificial lens into the eye. This is usually done as a day case under local anaesthetic. It usually gives good results.

Surgery: lens extraction

25
What is PE?
Phacoemulsification - Extraction of the lens through anterior capsule - irrigation and aspiration of cortical material in posterior capsular bag (most common procedure for cataract surgery uses smaller incisions, rapid healing, better rehab
26
What should be considered in surgery for cataracts?
1. degree of disability 2. opinion of patient 3. visual acuity 4. ocular pathology 5. general health 6. age 7. biometry of lens needed for each patient
27
By which method is cataract surgery done by?
phacoemulsification
28
What are the complications of cataract surgery?
1. Posterior capsule opacification 2. Vitreous loss 3. Retinal detachment 4. Endophthalmitis serious complication of cataract surgery. It is inflammation of the inner contents of the eye, usually caused by infection. It can be treated with intravitreal antibiotics injected into the eye. This can lead to loss of vision and loss of the eye itself.
29
Presentation of acute bacterial endophthalmitis
Pain and marked visual loss with an absent or poor red reflex Corneal haze, hypopyon and exudates
30
What bacteria cause acute bacterial endophthalmitis?
staph epidermidis Staph aureus Pseudomonas - treated with intracitreal antibiotics
31
What investigations are done for acute bacterial endophthalmitis?
Ocular B scan
32
What is AMD?
degeneration in the macular that cause a progressive deterioration in vision. In the UK it is the most common cause of blindness
33
What is the macula | What is it made of?
Central area of the retina 4 layers: choroid layer (contains blood vessels that provide the blood supply to the macula) Above that is Bruch’s membrane. Above Bruch’s membrane there is the retinal pigment epithelium and above that are the photoreceptors. Drusen are yellow deposits of proteins and lipids that appear between the retinal pigment epithelium and Bruch’s membrane - common to both wet and dry AMD
34
What are the two types of AMD?
Dry: 90% Wet: 10%
35
What features are common to both wet and Dry AMD?
Drusen Atrophy of the retinal pigment epithelium Degeneration of the photoreceptors
36
What is Wet AMD?
In wet AMD there is development of new vessels growing from the choroid layer into the retina. These vessels can leak fluid or blood and cause oedema and more rapid loss of vision. A key chemical that stimulates the development of new vessels is vascular endothelial growth factor (VEGF) and this is the target of medications to treat wet AMD
37
What are the risk factors for AMD?
``` Age Smoking White or Chinese ethnic origin Family history Cardiovascular disease ```
38
What are the presenting features of AMD?
Gradual worsening central visual field loss Reduced visual acuity Crooked or wavy appearance to straight lines
39
How should you examine a patient with ?AMD?
Snellen chart Scotoma (a central patch of vision loss) seen Amsler grid test can be used to assess the distortion of straight lines Fundoscopy. Drusen are the key finding. Slit-lamp biomicroscopic fundus examination by a specialist can be used to diagnose AMD. Optical coherence tomography is a technique used to gain a cross-sectional view of the layers of the retina. It can be used to diagnose wet AMD. Fluorescein angiography (not for exams)
40
What is the management of AMD?
``` Refer to ophthalmology Dry: no specific treatment Avoid smoking Control blood pressure Vitamin supplementation? ``` Wet: Anti-VEGF medications (Vascular endothelial growth factor is involved in the development of new blood vessels in the retina) ranibizumab, bevacizumab and pegaptanib block VEGF and slow the development of new vessels - injected into vitreous chamber once a month

CP2 Ophthalmology (14 decks)

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