Debilitating Eye Diseases

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Debilitating Eye Diseases

• By
• Ma. Teresa G. Martinez, M.D.
• International Eye Institute
• St. Lukes Medical Center

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

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Diabetic Retinopathy

• Non-Proliferative
• mild, moderate,
• severe, very severe
• Proliferative
• early
• high risk

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

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HPN Retinopathy

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

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

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Complications

• Central Retinal Artery Occlusion
• Branch Retinal Artery Occlusion
• Central Retinal Vein Occlusion
• Branch Retinal Vein Occlusion

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Central Retinal Artery Occlusion

• Caused by atherosclerosis-related thrombosis
  (ophthalmic artery)
• S/Sx
• acute and profound loss of vision
• pale retina
• cherry red spot

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• Treatment
• Immediate (within 90 mins)
• ? IOP by ocular massage
• Anterior Chamber Paracentesis or
• Retrobulbar Anesthesia
• Inhalation Therapy (95 O2/ 5 CO2)
• Oral Acetazolamide Aspirin

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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

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

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Central Retinal Vein Occlusion

• Non-Ischaemic (most common)
• moderate loss of visual acuity
• FA shows venous stasis but good retinal
  capillary perfusion
• 50 - normal or near normal visual acuity
• Chronic Cystoid macular edema poor visual
  acuity

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

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Branch Retinal Vein Occlusion

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

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Glaucoma

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

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Early Disc Changes

• Advanced Disc Changes

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

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Age-Related Macular Degeneration

• Severe central visual acuity loss in one or both
  eyes
• Types
• Nonneovascular
• Neovascular

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Nonneovascular Neovascular
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• S/Sx
• Decrease or loss in central visual acuity
• Treatment
• Education follow up
• Micronutrients
• Laser treatment (PDT)
• Intravitreal injection of steroids
• Intravitreal injection of anti-VEGF

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

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

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Uveitis

• Inflammation of the uveal tract
• Types
• Anterior
• Intermediate
• Posterior
• Panuveitis

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Anterior Uveitis

• Posterior Uveitis

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

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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.

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Visual Acuity

• Snellen Chart

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Visual Fields/ Perimetry
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Fluorescein Angiography
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B-Scan Ultrasound
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Optical Coherence Tomography
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• THANK YOU