ophthalmology for finals
DESCRIPTION
Ophthalmology for Finals. 3 rd February 2013 Dr Alexander Ross Dr Thomas Marjot. Content. Eye examination Anatomy Inflammatory conditions Lens and iris Retina and choroid Vascular disease Glaucoma Infectious eye disease Trauma Pupillary and visual pathways Eye movement disorders. - PowerPoint PPT PresentationTRANSCRIPT
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Ophthalmology for Finals
3rd February 2013Dr Alexander RossDr Thomas Marjot
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Content
• Eye examination• Anatomy• Inflammatory conditions• Lens and iris• Retina and choroid• Vascular disease• Glaucoma• Infectious eye disease• Trauma• Pupillary and visual pathways• Eye movement disorders
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Examination of the eye
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Retina and Choroid
Retinal disease
Macula Peripheral
•Blurred vision/ metamorphopsia
•Micropsia, macropsiaField loss
RPAMD
Dry Wet
Macular oedema
Night blindness
Retinal detachment
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Macular disease
• Age related macular degeneration
Pathogenesis
Bruch’s membrane - Drusen
VEGF choroid angiogenesis Subretinal neovascular membrane
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Investigation of AMD
• Clinical
• Fluorescein angiography
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Macular disease
• Age related macular degeneration
Pathogenesis
Bruch’s membrane - Drusen
VEGF choroid angiogenesis Subretinal neovascular membrane
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Treatment of AMD
• Dry – ?high dose antioxidants – Stop smoking
• Wet– Anti-VEGF
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Retina and Choroid
Retinal disease
Macula Peripheral
•Blurred vision/ metamorphopsia
•Micropsia, macropsiaField loss
RPAMD
Dry Wet
Macular oedema
Night blindness
Retinal detachment
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Macular oedema
Intraocular surgery
Inflammation (uveitis)
Retinal vascular disease
Retinitis pigmentosa
Cystoid macular oedema
Diabetic macular oedema
Rx NSAIDs, cortisone, Anti-VEGF
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Retina and Choroid
Retinal disease
Macula Peripheral
•Blurred vision/ metamorphopsia
•Micropsia, macropsiaField loss
RPAMD
Dry Wet
Macular oedema
Night blindness
Retinal detachment
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Retina and Choroid
Retinal disease
Macula Peripheral
•Blurred vision/ metamorphopsia
•Micropsia, macropsiaField loss
RPAMD
Dry Wet
Macular oedema
Night blindness
Retinal detachment
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Retinitis Pigmentosa
• Genetic disorder
• XR/AR/AD - rhodopsin
• Photoreceptors
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RP - symptoms
Night vision tunnel vision blurred
Cataracts
Macular oedema
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RP - investigation
• Field mapping
• Electroretinography
• DNA testing
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RP treatment
• Vitamin A
• Genetic therapy
• Mx of associated cataracts etc
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Extra points
• ?Deaf Usher
• ?Ophthalmoplegia Kearns-Sayre
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Retinal Vascular Disease
Vessel
Leak
Block Ischaemia
Lipid
Fluid
Blood
neoangiogenesis
Cotton wool spots
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Retinal Vascular Disease
Retinopathy
Diabetic
Hypertensive
Occlusive
Arterial
Venous
CRAO
BRAO
CRVO
BRVO
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Diabetic Retinopathy
• Commonest blindness of middle age
• Associated with cataracts, glaucoma, and extraocular muscle palsy
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Investigation
• Annual fundoscopy 5y after DM onset (DRP)
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Classification
• NON-PROLIFERATIVE
• PROLIFERATIVE
Background, preproliferative, maculopathy, proliferative
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Non-proliferative
• Nerve-fiber layer infarcts (cotton wool spots)
• Intraretinal hemorrhages
• Hard exudates
• Microvascular abnormalities
• MACULAR OEDEMA
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• New vessels lack pericytes
• Microaneurysms
• Disorganised blood supply
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Treatment
• Maculopathy – circinate laser treatment
• Proliferative – Photocoagulation
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Retinal Vascular Disease
Retinopathy
Diabetic
Hypertensive
Occlusive
Arterial
Venous
CRAO
BRAO
CRVO
BRVO
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Hypertensive retinopathy
Keith Wagener Barker (KWB)• Grade 1
– Generalised arteriolar constriction - seen as `silver wiring` and vascular tortuosities. Copper wiring.
– Hard opaque vessel wall
• Grade 2 – Grade 1 + AV nipping
• Grade 3 – Grade 2 + with cotton wool spots and flame-hemorrhages
• Grade 4 – Grade 3 + papilledema
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Retinal Vascular Disease
Retinopathy
Diabetic
Hypertensive
Occlusive
Arterial
Venous
CRAO
BRAO
CRVO
BRVO
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Arterial Occlusion
• Transient – Amaurosis fugax
• Permanent – sudden painless loss of vision
• Signs – atrophic retina – cherry red spot
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Retinal vein occlusion
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