Anterior chamber, Iris, Lens, Disc and Fundus Pathophysiology

Cataract

Etiology: Clouding of the lens which prevents light from reaching the retina and permitting vision. Usually bilaterally.
NSC, PSC or PPC
Risk Factors: trauma, age, sun exposure, possibly congenital
c/o: cloudy or foggy vision, glare from light sources, di

Nuclear Sclerotic Cataract (NSC)

-Most common type
-Gradual hardening and yellowing of the central zone of the lens (nucleus), then expanding to other layers
-Progression changes the eyes ability to focus and close up vision
- Progresses over years to affect vision

posterior subcapsular cataract

-Affects one's reading and night vision
-Interferes with reading and created halo effect/glare around lights
-Small opaque or cloudy area on the posterior lens ( beneath lens capsule)
-Steroids, diabetes, extreme nearsightedness, retinitis pigmentosa
-Dev

Posterior polar cataract

Round, discoid, opaque mass composed of malformed, distorted lens fibers located in posterior lens

Age Related Macular Degeneration (ARMD)

Etiology: Macula degeneration leading to severe loss of vision
c/o: Decreased, distorted or dimmed vision, blurry patches of vision, decreased or altered color perception
PE:
Wet: abnormal blood vessel growth, leaking fluid or blood, retinal detachment
Dr

Wet AMD

Usually results in irreversible loss of vision

Dry AMD

Progresses slowly and vision loss/reduction is not as severe as with wet AMD

Posterior Vitreous Detachment (PVD)

Etiology: Back of vitreous, which lays over the retina, slowly pulls away from the retina
Risk factors: High mypoes or advanced age
C/o: flashes, floaters, darkness in peripheral field of vision
Tx: Observation. Laser may be considered if retinal tear is

Glaucoma Suspect

Etiology: Individual with 1+ risk factors that may lead to glaucoma
C/o: Transient focal neurological deficit
Changes in speech,vision, strength or sensation
Scribe alert: Patient does not yet have glaucomatous optic nerve damage or visual field defect. I

Primary open angle glaucoma

Etiology: Multifactorial chronic progressive optic neuropathy. Accompanied by elevated IOP, cupping and atrophy of optic disc and acquired loss of optic nerve fibers. Elevated IOP creates pressure on optic nerve
C/o: Elevated IOP, Tunnel vision, Visual fi

Surgical Intervention of Primary Open Angle Glaucoma

indicated with glacomatous optic neuropathy worsens at any given level of IOP and patient is on max tolerated medial therapy

Argon Laser Trabeculoplasty (ALT)

Surgical Intervention of Primary Open Angle Glaucoma:
A laser beam is used at anterior and posterior trabecular meshwork to widen the hold and thus improve aqueous outflow. Results in reduced IOP

Selective Laser Trabeculoplasty (SLT)

Surgical Intervention of Primary Open Angle Glaucoma:
A laser targets pigmented cells of trabecular meshwork to increase aqueous outflow and lower IOP

Trabeculectomy

Surgical Intervention of Primary Open Angle Glaucoma:
A section of trabecular meshwork is removed to increase outflow of aqueous humor and lower IOP

Drainage implant

Surgical Intervention of Primary Open Angle Glaucoma:
A tube is placed in the anterior chamber to shunt aqueous humor to an equatorial reservoir and then posteriorly to be absorbed in the subconjuctival space resulting in decreased IOP

Ciliary Body Ablation

Surgical Intervention of Primary Open Angle Glaucoma:
A portion of the non-pigmented ciliary epithelium is destroyed, limiting the production of aqueous humor. Last resort of treatment

Narrow angle glaucoma

Etiology: Result of the iris being pushed forward due to elevated IOP, which leads to blocked trabecular meshwork creating a narrow drainage able of the eye
C/o: Elevated IOP, tunnel vision, visual field loss, eye pain/erythema, Nausea /vomiting, dilated

Epiretinal membrane

Etiology: Thickening(scar tissue) of the back layer of the vitreous gel secondary to intraocular surgery, trauma, detached retina, old age, ocular inflammation or diabetic eye disease. ERM can lead to secondary macular edema or macular holes
Risk factors:

Lattice Degeneration

Etiology: Peripheral retina become atrophic(thinned on outer edges) in a lattice pattern (crisscross), potentially causing tears, breaks or holes in retina and eventually retinal detachment. Cause is unknown, but thought to be related to vascular insuffic

Retinal Tear or Detachment

Etiology:
Tear: Vitreous gel pulls loose or separated from its attachment to retina. This exerts traction on retina and causes a tear or hole. If vitreous gel passes through tear and accumulates behind the retina, detachment can occur.
Detachment: Retina