Download presentation
Presentation is loading. Please wait.
1
Ophthalmology for Finals
3rd February 2013 Dr Alexander Ross Dr Thomas Marjot
2
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
3
Examination of the eye
5
Retina and Choroid Retinal disease Macula Peripheral
Blurred vision/ metamorphopsia Micropsia, macropsia Field loss Night blindness AMD Macular oedema Retinal detachment RP Dry Wet
6
Macular disease Age related macular degeneration Pathogenesis
Commonest irreverisible loss of vision in west Bruch’s membrane - Drusen VEGF choroid angiogenesis Subretinal neovascular membrane
7
Investigation of AMD Clinical Fluorescein angiography
10
Geographic atrophy – degeneration of RPE
11
Macular disease Age related macular degeneration Pathogenesis
Commonest irreverisible loss of vision in west Bruch’s membrane - Drusen VEGF choroid angiogenesis Subretinal neovascular membrane
12
Autofluorescence optical coherence tomography
14
Amsler
15
Treatment of AMD Dry Wet ?high dose antioxidants Stop smoking
Anti-VEGF 8% over 75s
16
Retina and Choroid Retinal disease Macula Peripheral
Blurred vision/ metamorphopsia Micropsia, macropsia Field loss Night blindness AMD Macular oedema Retinal detachment RP Dry Wet
17
Macular oedema Intraocular surgery Inflammation (uveitis)
Cystoid macular oedema Retinitis pigmentosa Retinal vascular disease Diabetic macular oedema Rx NSAIDs, cortisone, Anti-VEGF
19
Retina and Choroid Retinal disease Macula Peripheral
Blurred vision/ metamorphopsia Micropsia, macropsia Field loss Night blindness AMD Macular oedema Retinal detachment RP Dry Wet
20
Retina and Choroid Retinal disease Macula Peripheral
Blurred vision/ metamorphopsia Micropsia, macropsia Field loss Night blindness AMD Macular oedema Retinal detachment RP Dry Wet
21
Retinitis Pigmentosa Genetic disorder XR/AR/AD - rhodopsin
Photoreceptors
22
RP - symptoms Night vision tunnel vision blurred Cataracts
Macular oedema
23
RP - investigation Field mapping Electroretinography DNA testing
24
Clumps of pigmentation
Attenuation of retinal arterioles optic atrophy
30
RP treatment Vitamin A Genetic therapy Mx of associated cataracts etc
31
Extra points ?Deaf Usher ?Ophthalmoplegia Kearns-Sayre
32
Retinal Vascular Disease
Lipid Fluid Leak Blood Vessel Obstruction of axoplasmic flow. Central – thicker retina – white scatter light neoangiogenesis Block Ischaemia Cotton wool spots
33
Diabetic Retinopathy Hypertensive Retinal Vascular Disease CRAO Arterial Occlusive BRAO CRVO Venous BRVO
34
Diabetic Retinopathy Commonest blindness of middle age
Associated with cataracts, glaucoma, and extraocular muscle palsy
35
Investigation Annual fundoscopy 5y after DM onset (DRP)
36
Classification NON-PROLIFERATIVE PROLIFERATIVE
Background, preproliferative, maculopathy, proliferative
37
Non-proliferative Nerve-fiber layer infarcts (cotton wool spots)
Intraretinal hemorrhages Hard exudates Microvascular abnormalities Macular oedema
50
New vessels lack pericytes
Microaneurysms Disorganised blood supply
51
Treatment Maculopathy – circinate laser treatment
Proliferative – Photocoagulation
52
Diabetic Retinopathy Hypertensive Retinal Vascular Disease CRAO Arterial Occlusive BRAO CRVO Venous BRVO
53
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
59
Diabetic Retinopathy Hypertensive Retinal Vascular Disease CRAO Arterial Occlusive BRAO CRVO Venous BRVO
60
Arterial Occlusion Transient – Amaurosis fugax
Permanent – sudden painless loss of vision Signs – atrophic retina – cherry red spot Visible choroid through retina
64
Retinal vein occlusion
Similar presentations
