Professional Documents
Culture Documents
Common Ocular Disorders
Common Ocular Disorders
• Hereditary
– Autosomal dominant form most common
• Genetic and Metabolic Diseases
– Down syndrome
– Marfan’s syndrome
– Myotonic Dystrophy
• Maternal Infections
– Rubella, Syphilis, Toxoplasmosis, Varicella
• Ocular Anomalies
– Aniridia-Absence of iris at birth
• Toxic
– Corticosteroids, Radiation
• Trauma
Risk Factors In Adults
Cherry spot
Investigations for retinal vascular disease
Drusen
Exudative AMD
DIABETES AND THE EYE
EPIDEMIOLOGY
• Commonest cause of blindness in the
population of working age in developed
countries
• Prevalence of DR of any severity in the
diabetic population is 30% and prevalence
of blindness due to DR is approximately 5%
PATHOGENESIS
RISK FACTORS
• Duration of DM
• Control of DM. Will not prevent but delays
• Hypertension
• Renal Disease
• Pregnancy
• Obesity, hyperlipidaemia, smoking,
anaemia
CLINICAL CLASSIFICATION OF DIABETIC
RETINOPATHY
• Background
• Pre-proliferative
• Proliferative
• End-stage diabetic eye disease
Background
Microaneurism
Exudate
Blot haemorrhage
Diabetic maculopathy
Hard exudate
Pre-proliferative
CWS
Vascular
tortuosity
Microaneurism
Proliferative retinopathy
NVD NVE
Pre-retinal
haemorrhage
Rubeosis iridis
TREATMENT
• LASER: Light
Amplification by the
Stimulated Emission of
Radiation
– Focal
– Grid
– Panretinal
photocoagulation
SCREENING
• No retinopathy or BDR with normal vision
– See yearly, or sooner if vision deteriorates
• Refer to ophthalmologist
– BDR with macular changes
– BDR with decrease in vision
– Pre-proliferative retinopathy
– Proliferative retinopathy
• Injections
• Surgery
NEURO-OPHTHALMOLOGY
Clinical Examination
• Visual Acuity
• Colour Vision
• Visual Fields
• Pupils
The swollen optic disc
•Papilloedema
•Papillitis
•Malignant hypertension
•Ischaemic optic neuropathy
•Diabetic optic neuropathy
•CRVO
•Intraocular inflammation
The pale optic disc
•Congenital
•Secondary to
• raised ICP
• vascular
retinal disease
• optic neuritis
• optic nerve
compression
• trauma
•Glaucoma
Papilloedema
Blurred optic
• Disc swelling secondary to raised ICP disc margin
• Headache Haemorrhages
– Worse in the morning
– Valsalva manouver
• Nausea and projectile vomiting
Small optic
• Horizontal diplopia (VI palsy) CWS cup
• Causes
– Space occupying lesion
– Intracranial hypertension Disc pallor
• Idiopathic
• Drugs
• Endocrine
– Severe hypertension
Vessel attenuation
Pupil
Chiasma
Posterior cerebral
artery
III CN
Internuclear Ophthalmoplegia
• Defective adduction of the
ipsilateral eye
• Nystagmus of the contralateral
(abducting) eye
• NORMAL CONVERGENCE
• Causes
– Young patients
• Bilateral
• Demyelination
– Older patients
• Unilateral
• Vascular, tumours
Myasthenia Gravis
• Fatigability
• Double vision
• Lid twitch
• Ptosis
• Normal reflexes & sensation
Localising the lesion
• Monocular visual field defects indicate lesions
anterior to the optic chiasm
• Bitemporal defects are the hallmark of chiasmal
lesions
• Binocular homonymous hemianopia result from
lesions in the contralateral postchiasmal region
• Binocular quadrantanopias reflect optic tract
lesions
Anatomy of Apex of Orbit
LPS
Optic Nerve
Annulus of Zinn
• Frontal sinus
• Sphenoidal sinus
• Maxillary sinus
• Ethamoidal air cells
Common lesions
• Proptosis
• Exophthalmos- endrocrinal
• Enophthalmos
• Pseudoproptosis-slight prominence of eyes
like myopia, paralysis of extra ocular muscles,
obese people, mullers stimulation by cocain
Proptosis and Exophthalmos
• Abnormal protrusion of eye ball is called
proptosis or exophthalmos.
• The term exophthalmos is reserved for
prominence of the eye secondary to thyroid
disease
Proptosis
• Abnormal protrusion of globe
• It may be Unilateral or Bilateral
• Unilateral – caused by orbital cellulitis, idiopathic
orbital inflammatory disease, thrombosis of orbital
vein, arterio-venous aneurysms, tumors of structures
of orbit , orbital haemorrahge , emphysema.
• Bilateral – endocrine exophthalmos , cavernous sinus
thrombosis , symmetrical orbital tumors, oxycephaly
- diminished orbital volume
Proptosis
Proptosis in children
• Dermoid and epidermoid cyst
• Capillary haemangioma
• Optic nerve glioma
• Rhabdomyosarcoma
• Leukaemias
• Metastatic neuroblastoma
• Plexiform neurofibromatosis
• Lymphomas
Mass lesion in Left orbit
Due Retinoblastoma Stage III
Proptosis in adults
• Metastases – (of malignancy) from breast,
lung, GIT
• Cavernous haemangiomas
• Mucocele
• Lymphoid tumors
• Meningiomas
Causes of proptosis in different in different
locations
Extra conal lesions Intra conal lesions Muscular disorders
Dermoid cyst Cavernous haemangioma Thyroid
ophthalmopathy
Rhabdomyosarcoma
GIANT CELL ARTERITIS
(Temporal or Cranial Arteritis)
• Idiopathic vasculitis
• Same disease spectrum as polymyalgia
rheumatica
• Mainly women 65-80 years old
• Medium and large arteries in head & neck
involved
67
GIANT CELL ARTERITIS
Presentation
• Headache
• Scalp tenderness
• Thickened temporal arteries
• Jaw claudication
• Acute visual loss
• Weight loss, anorexia, fever, night sweats,
malaise & depression
68
GIANT CELL ARTERITIS
Ocular Complications
• Transient monocular
visual loss (amaurosis
fugax)
• Visual loss due to
– Central retinal artery
occlusion (CRAO) or
– Anterior ischaemic
optic neuropathy
(AION)
• Visual field defects
69
GIANT CELL ARTERITIS
Management
• ESR if suspected
• Start high dose steroids immediately to
prevent stroke or second eye involvement
• Temporal artery biopsy within a week of
starting steroids
70
GIANT CELL ARTERITIS Temporal Artery
Biopsy
• Arteries have skip lesions
• ultrasound/Doppler may
help identify involved
areas
• If positive, confirms
diagnosis – helpful in
management of future
disease
• If negative, doesn’t
exclude diagnosis, but
need to think about an
alternative diagnosis
71
GIANT CELL ARTERITIS
Histopathology
• Granulomatous cell
infiltration
• Giant cells
• Disruption of internal
elastic lamina
• Proliferation of intima
• Occlusion of lumen
72
GIANT CELL ARTERITIS
Treatment
73
Refractive error
Emmetropia
• Adequate correlation between axial length
and refractive power
• Parallel light rays fall on the retina (no
accommodation)
Ametropia (Refractive error)
• Mismatch between axial length and refractive
power
• Parallel light rays don’t fall on the retina (no
accommodation)
– Nearsightedness (Myopia)
– Farsightedness (Hyperopia)
– Astigmatism
– Presbyopia
Accommodation
• Emmetropic eye
– object closer than 6 M send divergent light that focus
behind retina , adaptative mechanism of eye is
increase refractive power by accommodation
• Helm-holtz theory
– contraction of ciliary muscle -->decrease tension in
zonule fibers -->elasticity of lens capsule mold lens
into spherical shape -->greater dioptic power
-->divergent rays are focused on retina
– contraction of ciliary muscle is supplied by
parasympathetic third nerve
Myopia