Download - Ophthalmology for Finals
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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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