Makindo Medical Notes.com

No eye pain or redness unless lens-induced glaucoma or uveitis

About

• Cataract is permanent opacity of the lens
• May be congenital or acquired
• Globally, untreated cataract is the most common cause of visual impairment

Aetiology

• The lens thickens and opacifies with age
• Cataract detected in > 50% over the age 65

Risks

• Increasing age, Diabetes, Family history
• Steroid use, UV light, radiation
• Congenital : TORCH infection, Galactosaemia
• Wilson’s disease: ‘sunflower’ cataract.
• Hypertension, Smoking, Dystrophia myotonica
• Radiation UV exposure, Uveitis

Classification of different types

• Nuclear - central seen in old age
• Polar - localised seen in inherited disorders
• Subcapsular - related to steroid use
• Dot - Diabetes

Clinical

• Gradual loss of vision, Blurred vision, Glare
• Haloes around lights, Changing refractive index
• Loss of red reflex
• Children - amblyopia, squint, nystagmus

Investigations

• Blood sugar to exclude diabetes
• Screen for Wilsons disease in selected cases

Management

• Consider assessing and managing refractive errors and if not benefit then consider surgery.
• Ophthalmology referral for day-case surgical incision and ultrasonic phacoemulsification with intraocular lens (IOL) implant. under local anaesthesia and sedation such as Midazolam/Propofol. Anticoagulation can often be continued.
• Operative complications: Infection, Posterior capsule rupture, vitreous haemorrhage, Glaucoma, Posterior capsule thickening and opacification which can be treated with laser therapy.
• Optimise diabetic management. Avoid steroids.