Download Debilitating Eye Diseases

Debilitating Eye Diseases
By
Ma. Teresa G. Martinez, M.D.
International Eye Institute
St. Luke’s Medical Center
 Diabetes mellitus
 Hypertension
 Glaucoma
 Age-Related Macular Degeneration
 Retinal Detachment
 Uveitis
Diabetic Retinopathy
 Non-Proliferative
mild, moderate,
severe, very severe
 Proliferative
early
high risk
 S/Sx
painless blurring of vision (gradual or sudden)
retinal changes
 Treatment
blood sugar control
panretinal photocoagulation
pars plana vitrectomy
HPN Retinopathy
 Modified Scheie Classification
Grade 0 No changes
Grade 1 Barely detectable arterial narrowing
Grade 2 Obvious arterial narrowing with
focal irregularities
Grade 3 Grade 2 plus retinal hges and/ or
exudate
Grade 4 Grade 3 plus disc swelling
 S/Sx
blurring of vision
retinal changes
 Treatment
Blood pressure control
Complications
 Central Retinal Artery Occlusion
 Branch Retinal Artery Occlusion
 Central Retinal Vein Occlusion
 Branch Retinal Vein Occlusion
Central Retinal Artery Occlusion
 Caused by atherosclerosis-related
thrombosis (ophthalmic artery)
 S/Sx
acute and profound loss of vision
pale retina
cherry red spot
 Treatment
Immediate (within 90 mins)
↓ IOP by ocular massage
Anterior Chamber Paracentesis or
Retrobulbar Anesthesia
Inhalation Therapy (95% O2/ 5% CO2)
Oral Acetazolamide & Aspirin
Branch Retinal Artery Occlusion
 Most commonly caused by emboli
 Cholesterol, Platelet-fibrin, Calcific
 Other associations:
trauma, coagulation disorders, sickle cell
disease, oral contraceptives, mitral valve
prolapse, inflammatory &/or infectious
etiologies, connective tissue disorders
 S/Sx
Acute & severe altitudinal visual field defect
Pale retina in the area supplied by the affected
artery
 Treatment
Mgt is directed toward determination of systemic
etiologic factors
No specific ocular therapy proven to improve
visual prognosis
Central Retinal Vein Occlusion
 Non-Ischaemic (most common)
moderate loss of visual acuity
FA shows venous stasis but good retinal capillary
perfusion
50% - normal or near normal visual acuity
Chronic Cystoid macular edema – poor visual
acuity
 Ischaemic
Severe loss of visual acuity
Marked tortuosity & engorgement of retinal veins
Retinal hemorrhages, Cotton wool spots
Severe optic disc edema & hyperemia
Visual acuity is permanently impaired
Monthly follow-up for 6 months
(+) neovascularization – PRP treatment
Tx of associated medical
condition
Branch Retinal Vein Occlusion
 Sudden blurring of vision
Metamorphopsia or relative visual field defect
Dilated & tortuous veins, hemorrhages, edema,
cotton wool spots
Complications- chronic macular edema &
neovascularization
Within 6 mos 50% of eyes
w/ collaterals will have
better visual acuity
Glaucoma
 Increase in IOP, Optic Nerve changes,
Visual Field defects
 Types:
Congenital, Infantile, Juvenile
Open Angle (Primary, Secondary)
Closed Angle (Primary, Secondary)
Early Disc Changes
Advanced Disc Changes
 S/Sx
Decrease or loss in peripheral vision,
eye pain with or without headache, eye redness,
haloes around light
Optic Nerve changes
 Treatment
Medical – oral, IV, eyedrops
Surgical
Laser or Cryotherapy
Age-Related Macular Degeneration
 Severe central visual acuity loss in one or
both eyes
 Types:
Nonneovascular
Neovascular
Nonneovascular
Neovascular
 S/Sx :
Decrease or loss in central visual acuity
 Treatment
Education & follow up
Micronutrients
Laser treatment (PDT)
Intravitreal injection of steroids
Intravitreal injection of anti-VEGF
Retinal Detachment
 Types:
Rhegmatogenous – liquefied vitreous
passing through a retinal break into the
potential space between the sensory
retina and the RPE
Tractional –caused by proliferative membranes that contract & elevate the retina
Exudative – caused by retinal or choroidal diseases in which leakage of fluid
accumulates beneath the sensory retina
 S/Sx:
light flashes, wavy or watery vision, veil or
curtain obstructing vision, shower of floaters
that resemble spots, bugs or spider webs &
sudden decrease of vision
 Treatment
Surgery : Scleral Buckling
Pneumatic retinopexy
Cryotherapy, Laser or Diathermy
Vitrectomy
Uveitis
 Inflammation of the uveal tract
 Types:
Anterior
Intermediate
Posterior
Panuveitis
Anterior Uveitis
Posterior Uveitis
 S/Sx
floaters, blurring of vision, eye redness, eye pain,
systemic manifestations
anterior chamber findings, retinal changes
 Treatment
steroids
immunosuppressives
surgery
Legal Blindness
 Visual acuity of 20/200 or worse in the
better eye w/ corrective lenses (20/200
means that a person at 20 ft from an eye chart
can see what a person w/ normal vision can see
at 200 ft)
OR
 Visual field restriction to 20 degrees
diameter or less (tunnel vision) in the
better eye.
Visual Acuity
 Snellen Chart
Visual Fields/ Perimetry
Fluorescein Angiography
B-Scan Ultrasound
Optical Coherence Tomography
THANK YOU