Transcript Document
Ophthalmology for Finals 3rd 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 Examination of the eye Retina and Choroid Retinal disease Macula Peripheral •Blurred vision/ metamorphopsia Field loss •Micropsia, macropsia AMD Dry Wet Macular oedema Retinal detachment Night blindness RP 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 Field loss •Micropsia, macropsia AMD Dry Wet Macular oedema Retinal detachment Night blindness RP Macular oedema Intraocular surgery Inflammation (uveitis) Cystoid macular oedema Retinitis pigmentosa Retinal vascular disease Rx Diabetic macular oedema NSAIDs, cortisone, Anti-VEGF Retina and Choroid Retinal disease Macula Peripheral •Blurred vision/ metamorphopsia Field loss •Micropsia, macropsia AMD Dry Wet Macular oedema Retinal detachment Night blindness RP Retina and Choroid Retinal disease Macula Peripheral •Blurred vision/ metamorphopsia Field loss •Micropsia, macropsia AMD Dry Wet Macular oedema Retinal detachment Night blindness RP 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 Lipid Leak Fluid Blood Vessel neoangiogenesis Block Ischaemia Cotton wool spots Diabetic Retinopathy Hypertensive Retinal Vascular Disease Arterial Occlusive CRAO BRAO Venous 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 Diabetic Retinopathy Hypertensive Retinal Vascular Disease Arterial Occlusive CRAO BRAO Venous 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 Diabetic Retinopathy Hypertensive Retinal Vascular Disease Arterial Occlusive CRAO BRAO Venous CRVO BRVO Arterial Occlusion • Transient – Amaurosis fugax • Permanent – sudden painless loss of vision • Signs – atrophic retina – cherry red spot Retinal vein occlusion