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

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Presentation on theme: "Debilitating Eye Diseases By Ma. Teresa G. Martinez, M.D. International Eye Institute St. Luke’s Medical Center."— Presentation transcript:

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

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3  Diabetes mellitus  Hypertension  Glaucoma  Age-Related Macular Degeneration  Retinal Detachment  Uveitis

4 Diabetic Retinopathy  Non-Proliferative mild, moderate, mild, moderate, severe, very severe severe, very severe  Proliferative early early high risk high risk

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

6 HPN Retinopathy  Modified Scheie Classification Grade 0 No changes Grade 1 Barely detectable arterial narrowing Grade 2 Obvious arterial narrowing with focal irregularities focal irregularities Grade 3 Grade 2 plus retinal hges and/ or exudate exudate Grade 4 Grade 3 plus disc swelling

7  S/Sx blurring of vision blurring of vision retinal changes retinal changes  Treatment Blood pressure control Blood pressure control

8 Complications  Central Retinal Artery Occlusion  Branch Retinal Artery Occlusion  Central Retinal Vein Occlusion  Branch Retinal Vein Occlusion

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

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

11 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 trauma, coagulation disorders, sickle cell disease, oral contraceptives, mitral valve prolapse, inflammatory &/or infectious etiologies, connective tissue disorders

12  S/Sx Acute & severe altitudinal visual field defect Acute & severe altitudinal visual field defect Pale retina in the area supplied by the affected artery Pale retina in the area supplied by the affected artery  Treatment Mgt is directed toward determination of systemic etiologic factors Mgt is directed toward determination of systemic etiologic factors No specific ocular therapy proven to improve visual prognosis No specific ocular therapy proven to improve visual prognosis

13 Central Retinal Vein Occlusion  Non-Ischaemic (most common) moderate loss of visual acuity moderate loss of visual acuity FA shows venous stasis but good retinal capillary perfusion FA shows venous stasis but good retinal capillary perfusion 50% - normal or near normal visual acuity 50% - normal or near normal visual acuity Chronic Cystoid macular edema – poor visual acuity Chronic Cystoid macular edema – poor visual acuity

14  Ischaemic Severe loss of visual acuity Severe loss of visual acuity Marked tortuosity & engorgement of retinal veins Marked tortuosity & engorgement of retinal veins Retinal hemorrhages, Cotton wool spots Retinal hemorrhages, Cotton wool spots Severe optic disc edema & hyperemia Severe optic disc edema & hyperemia Visual acuity is permanently impaired Visual acuity is permanently impaired Monthly follow-up for 6 months Monthly follow-up for 6 months (+) neovascularization – PRP treatment (+) neovascularization – PRP treatment Tx of associated medical Tx of associated medical condition condition

15 Branch Retinal Vein Occlusion  Sudden blurring of vision Metamorphopsia or relative visual field defect Metamorphopsia or relative visual field defect Dilated & tortuous veins, hemorrhages, edema, cotton wool spots Dilated & tortuous veins, hemorrhages, edema, cotton wool spots Complications- chronic macular edema & neovascularization Complications- chronic macular edema & neovascularization Within 6 mos 50% of eyes Within 6 mos 50% of eyes w/ collaterals will have w/ collaterals will have better visual acuity better visual acuity

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

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18 Early Disc Changes Advanced Disc Changes

19  S/Sx Decrease or loss in peripheral vision, Decrease or loss in peripheral vision, eye pain with or without headache, eye redness, haloes around light eye pain with or without headache, eye redness, haloes around light Optic Nerve changes Optic Nerve changes  Treatment Medical – oral, IV, eyedrops Medical – oral, IV, eyedrops Surgical Surgical Laser or Cryotherapy Laser or Cryotherapy

20 Age-Related Macular Degeneration  Severe central visual acuity loss in one or both eyes  Types: Nonneovascular Nonneovascular Neovascular Neovascular

21 Nonneovascular Neovascular

22  S/Sx : Decrease or loss in central visual acuity Decrease or loss in central visual acuity  Treatment Education & follow up Education & follow up Micronutrients Micronutrients Laser treatment (PDT) Laser treatment (PDT) Intravitreal injection of steroids Intravitreal injection of steroids Intravitreal injection of anti-VEGF Intravitreal injection of anti-VEGF

23 Retinal Detachment

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

25  S/Sx: light flashes, wavy or watery vision, veil or curtain obstructing vision, shower of floaters light flashes, wavy or watery vision, veil or curtain obstructing vision, shower of floaters that resemble spots, bugs or spider webs & that resemble spots, bugs or spider webs & sudden decrease of vision sudden decrease of vision  Treatment Surgery : Scleral Buckling Surgery : Scleral Buckling Pneumatic retinopexy Pneumatic retinopexy Cryotherapy, Laser or Diathermy Cryotherapy, Laser or Diathermy Vitrectomy Vitrectomy

26 Uveitis  Inflammation of the uveal tract  Types: Anterior Anterior Intermediate Intermediate Posterior Posterior Panuveitis Panuveitis

27 Anterior Uveitis Anterior Uveitis Posterior Uveitis

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

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

30 Visual Acuity  Snellen Chart

31 Visual Fields/ Perimetry

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35 Fluorescein Angiography

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37 B-Scan Ultrasound

38 Optical Coherence Tomography

39 THANK YOU


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