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