Ophthalmology for Finals

3rd February 2013Dr Alexander RossDr 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

Examination of the eye

Retina and Choroid

Retinal disease

Macula Peripheral

•Blurred vision/ metamorphopsia

•Micropsia, macropsiaField loss

RPAMD

Dry Wet

Macular oedema

Night blindness

Retinal detachment

Macular disease

• Age related macular degeneration

Pathogenesis

Bruch’s membrane - Drusen

VEGF choroid angiogenesis Subretinal neovascular membrane

Investigation of AMD

• Clinical

• Fluorescein angiography

Macular disease

• Age related macular degeneration

Pathogenesis

Bruch’s membrane - Drusen

VEGF choroid angiogenesis Subretinal neovascular membrane

Treatment of AMD

• Dry – ?high dose antioxidants – Stop smoking

• Wet– Anti-VEGF

Retina and Choroid

Retinal disease

Macula Peripheral

•Blurred vision/ metamorphopsia

•Micropsia, macropsiaField loss

RPAMD

Dry Wet

Macular oedema

Night blindness

Retinal detachment

Macular oedema

Intraocular surgery

Inflammation (uveitis)

Retinal vascular disease

Retinitis pigmentosa

Cystoid macular oedema

Diabetic macular oedema

Rx NSAIDs, cortisone, Anti-VEGF

Retina and Choroid

Retinal disease

Macula Peripheral

•Blurred vision/ metamorphopsia

•Micropsia, macropsiaField loss

RPAMD

Dry Wet

Macular oedema

Night blindness

Retinal detachment

Retina and Choroid

Retinal disease

Macula Peripheral

•Blurred vision/ metamorphopsia

•Micropsia, macropsiaField loss

RPAMD

Dry Wet

Macular oedema

Night blindness

Retinal detachment

Retinitis Pigmentosa

• Genetic disorder

• XR/AR/AD - rhodopsin

• Photoreceptors

RP - symptoms

Night vision tunnel vision blurred

Cataracts

Macular oedema

RP - investigation

• Field mapping

• Electroretinography

• DNA testing

RP treatment

• Vitamin A

• Genetic therapy

• Mx of associated cataracts etc

Extra points

• ?Deaf Usher

• ?Ophthalmoplegia Kearns-Sayre

Retinal Vascular Disease

Vessel

Leak

Block Ischaemia

Lipid

Fluid

Blood

neoangiogenesis

Cotton wool spots

Retinal Vascular Disease

Retinopathy

Diabetic

Hypertensive

Occlusive

Arterial

Venous

CRAO

BRAO

CRVO

BRVO

Diabetic Retinopathy

• Commonest blindness of middle age

• Associated with cataracts, glaucoma, and extraocular muscle palsy

Investigation

• Annual fundoscopy 5y after DM onset (DRP)

Classification

• NON-PROLIFERATIVE

• PROLIFERATIVE

Background, preproliferative, maculopathy, proliferative

Non-proliferative

• Nerve-fiber layer infarcts (cotton wool spots)

• Intraretinal hemorrhages

• Hard exudates

• Microvascular abnormalities

• MACULAR OEDEMA

• New vessels lack pericytes

• Microaneurysms

• Disorganised blood supply

Treatment

• Maculopathy – circinate laser treatment

• Proliferative – Photocoagulation

Retinal Vascular Disease

Retinopathy

Diabetic

Hypertensive

Occlusive

Arterial

Venous

CRAO

BRAO

CRVO

BRVO

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

Retinal Vascular Disease

Retinopathy

Diabetic

Hypertensive

Occlusive

Arterial

Venous

CRAO

BRAO

CRVO

BRVO

Arterial Occlusion

• Transient – Amaurosis fugax

• Permanent – sudden painless loss of vision

• Signs – atrophic retina – cherry red spot

Retinal vein occlusion