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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,

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Debilitating Eye Diseases

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  1. Debilitating Eye Diseases By Ma. Teresa G. Martinez, M.D. International Eye Institute St. Luke’s Medical Center

  2. Diabetes mellitus • Hypertension • Glaucoma • Age-Related Macular Degeneration • Retinal Detachment • Uveitis

  3. Diabetic Retinopathy • Non-Proliferative mild, moderate, severe, very severe • Proliferative early high risk

  4. S/Sx painless blurring of vision (gradual or sudden) retinal changes • Treatment blood sugar control panretinal photocoagulation pars plana vitrectomy

  5. 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

  6. S/Sx blurring of vision retinal changes • Treatment Blood pressure control

  7. Complications • Central Retinal Artery Occlusion • Branch Retinal Artery Occlusion • Central Retinal Vein Occlusion • Branch Retinal Vein Occlusion

  8. Central Retinal Artery Occlusion • Caused by atherosclerosis-related thrombosis (ophthalmic artery) • S/Sx acute and profound loss of vision pale retina cherry red spot

  9. Treatment Immediate (within 90 mins) ↓ IOP by ocular massage Anterior Chamber Paracentesis or Retrobulbar Anesthesia Inhalation Therapy (95% O2/ 5% CO2) Oral Acetazolamide & Aspirin

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. Glaucoma • Increase in IOP, Optic Nerve changes, Visual Field defects • Types: Congenital, Infantile, Juvenile Open Angle (Primary, Secondary) Closed Angle (Primary, Secondary)

  16. Early Disc Changes Advanced Disc Changes

  17. 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

  18. Age-Related Macular Degeneration • Severe central visual acuity loss in one or both eyes • Types: Nonneovascular Neovascular

  19. Nonneovascular Neovascular

  20. 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

  21. Retinal Detachment

  22. Types: Rhegmatogenous – liquefied vitreous passing through a retinal break into the potential space between the sensory retina and the RPE Tractional –caused by proliferative mem- branes that contract & elevate the retina Exudative – caused by retinal or cho- roidal diseases in which leakage of fluid accumulates beneath the sensory retina

  23. 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

  24. Uveitis • Inflammation of the uveal tract • Types: Anterior Intermediate Posterior Panuveitis

  25. Anterior Uveitis Posterior Uveitis

  26. S/Sx floaters, blurring of vision, eye redness, eye pain, systemic manifestations anterior chamber findings, retinal changes • Treatment steroids immunosuppressives surgery

  27. Legal Blindness • Visual acuity of 20/200 or worse in the better eye w/ corrective lenses (20/200means 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.

  28. Visual Acuity • Snellen Chart

  29. Visual Fields/ Perimetry

  30. Fluorescein Angiography

  31. B-Scan Ultrasound

  32. Optical Coherence Tomography

  33. THANK YOU

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