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Ophthalmology for Finals

Ophthalmology for Finals. 3 rd February 2013 Dr Alexander Ross Dr Thomas Marjot. 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.

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Ophthalmology for Finals

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  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

  4. Retina and Choroid Retinal disease Macula Peripheral • Blurred vision/ metamorphopsia • Micropsia, macropsia Field loss Night blindness AMD Macular oedema Retinal detachment RP Dry Wet

  5. Macular disease • Age related macular degeneration Pathogenesis Bruch’s membrane - Drusen VEGF choroid angiogenesis  Subretinal neovascular membrane

  6. Investigation of AMD • Clinical • Fluorescein angiography

  7. Macular disease • Age related macular degeneration Pathogenesis Bruch’s membrane - Drusen VEGF choroid angiogenesis  Subretinal neovascular membrane

  8. Treatment of AMD • Dry • ?high dose antioxidants • Stop smoking • Wet • Anti-VEGF

  9. Retina and Choroid Retinal disease Macula Peripheral • Blurred vision/ metamorphopsia • Micropsia, macropsia Field loss Night blindness AMD Macular oedema Retinal detachment RP Dry Wet

  10. Macular oedema Intraocular surgery Inflammation (uveitis) Cystoid macular oedema Retinitis pigmentosa Retinal vascular disease Diabetic macular oedema Rx NSAIDs, cortisone, Anti-VEGF

  11. Retina and Choroid Retinal disease Macula Peripheral • Blurred vision/ metamorphopsia • Micropsia, macropsia Field loss Night blindness AMD Macular oedema Retinal detachment RP Dry Wet

  12. Retina and Choroid Retinal disease Macula Peripheral • Blurred vision/ metamorphopsia • Micropsia, macropsia Field loss Night blindness AMD Macular oedema Retinal detachment RP Dry Wet

  13. Retinitis Pigmentosa • Genetic disorder • XR/AR/AD - rhodopsin • Photoreceptors

  14. RP - symptoms Night vision  tunnel vision  blurred Cataracts Macular oedema

  15. RP - investigation • Field mapping • Electroretinography • DNA testing

  16. RP treatment • Vitamin A • Genetic therapy • Mx of associated cataracts etc

  17. Extra points • ?Deaf  Usher • ?Ophthalmoplegia  Kearns-Sayre

  18. Retinal Vascular Disease Lipid Fluid Leak Blood Vessel neoangiogenesis Block Ischaemia Cotton wool spots

  19. Diabetic Retinopathy Hypertensive Retinal Vascular Disease CRAO Arterial Occlusive BRAO CRVO Venous BRVO

  20. Diabetic Retinopathy • Commonest blindness of middle age • Associated with cataracts, glaucoma, and extraocular muscle palsy

  21. Investigation • Annual fundoscopy 5y after DM onset (DRP)

  22. Classification • NON-PROLIFERATIVE • PROLIFERATIVE Background, preproliferative, maculopathy, proliferative

  23. Non-proliferative • Nerve-fiber layer infarcts (cotton wool spots) • Intraretinalhemorrhages • Hard exudates • Microvascular abnormalities • Macular oedema

  24. New vessels lack pericytes • Microaneurysms • Disorganised blood supply

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