Cataract
Definition – An opacity in the normally transparent focusing lens of the
eye that, as it becomes denser, interferes with clears site.
Cataract means “waterfall”
Most common: aging
Less common: intraocular diseases, trauma, medications(steroids, etc),
and metabolic, endocrine, or congenital abnormalites
Maturity
• Immature Cataract - scattered
opacities are separated by clear
areas
• Mature Cataract - lens is totally
opaque
EPIDEMIOLOGY
• Most common cause of visual loss
in the adult population and cause of
treatable blindness
• By age 65, >90% of all people have
cataracts
• May develop at any age (essential
to detect in neonatal period to
prevent amblyopia)
MANAGEMENT
• Treatment is surgical removal
Surgery is often deferred until decreased vision interferes with
patient’s ability to perform routine activities
• Surgery not deferred for above reasons:
In neonates
When the cataract interferes with the diagnosis or treatment of other
ocular diseases, e.g., diabetes mellitus or a tumor
When the cataract causes other eye diseases, e.g. uveitis or glaucom
CATARACT
SURGERY
Intracapsular cataract
extraction
• removing the entire lens and
its surrounding capsule
Extracapsular extraction (The
current technique)
• removing only the lens
nucleous, its surrounding
cortex, and a portion of the
anterior capsule, leaving the
posterior capsule as a support
for an intraocular lens
CATARACT SURGERY
Phacoemulsification
• method of extracapsular
extraction using a high-frequency
ultrasound device to fragment
the hard nucleous of the lens into
smaller particles and then
aspirate them.
Advantage – small incision
Complications (rare):
• Retinal detachment
• Macular edema
• Chronic Uveitis
• Keratopathy
GLAUCOMA
Optic neuropathy, causes optic nerve
head changes and visual field changes.
GLAUCOMA IS A MAIN CAUSE OF
IRREVERSIBLE BLINDNESS
SIGNS
1. Elevated intraocular pressure is a
common, but not necessary feature
2. Optic Nerve Cupping
3. Visual field defects
Mechanism: Most common is
impaired outflow of aqueous
Visual field defects
Gonioscopy
• An important step in the assessment
of glaucoma is to visualize the angle
structures.
• Structures seen on gonioscopy of a
normal angle include Schwalbe’s line,
scleral spur and trabecular
meshwork.
• The angle is graded according to the
number of structures identified on
gonioscopy.
Gonioscopy
Classification of glaucoma
• Primary Open Angle Glaucoma
• Primary Angle Closure Glaucoma
• Congenital Glaucoma
• Secondary Glaucoma
Risk Factors for Glaucoma: 1. Age 2. Race: more common in blacks 3.
Family history of glaucoma 4. Cardiovascular diseases 5. Myopia 6.
Nutritional factors 7. Vasospastic disorders: migraine.
SYMPTOMS
• Sudden onset of severe eye pain
• Red eye
• Blurred vision
• Halos around lights
• Headache or brow ache becomes severe
• Nausea, vomiting.
MANAGEME
NT
• Medication (drops)
• Laser
• Surgery
Medication (drops)
1. Suppression of aqueous production:
2. Facilitation of aqueous outflow:
4. Reduction of vitreous volume: Hyperosmotic agents: Mannitol,
glycerin
LASER
2. Peripheral Iridotomy or Iridectomy
3. Argon Laser Trabeculoplasty (ALT):
Surgery
• Trabeculectomy
• Glaucoma drainage implant
• Cyclodestructive Procedures
