leading cause of blindness
age related macular degeneration
what causes age related macular degeneration, and what are the risk factors
chronic oxidative damage to the retinal pigment epithelium and choriocapillaris
age
smoking
family hx
two subtypes of age related macular degeneration
dry
- gradual vision loss
- difficulty reading and driving at night
- fundoscopy shows yellow subretinal drusen deposits
wet
- can progress to wet from dry
- acute vision loss- days to weeks
- metamorphopsia - distortion of straight lines due to subretinal hemorrhage or fluid accumulation
- fundoscopy shows grey-green subretinal discoloration with fluid or hemorrhage
treatment of age related macular degeneration
- smoking cessation counselling if applicable
- mod-severe AMD pts should take zinc and antioxidant vitamin supplements to prevent progression
- wet AMD requires tx with VEGF inhibitors- ranibizumab and bevacizumab to stabilize/reverse vision loss
clinical features of anterior uveitis (iritis)
photophobia with possible watery discharge
miotic pupil, red ring around iris (ciliary flush)
clinical features of angle closure glaucoma
fixed, mid-dilated pupil
common in older adults
headache with nausea and vomiting
common infectious complication of contact lens use? treatment?
bacterial keratitis
topical abx w/ pseudomonas coverage, ex. fluoroquinolone
clinical features and tx of episcleritis
- acute inflammation (redness ,tearing) of sclera, without involvement of uveal tract
- mild irritation
- normal visual acuity
- young patients, usually self limited
- systemic disease uncommon
tx with topical lubricants. topical nsaids for persistent discomfort
clinical features and tx of scleritis
- subacute diffuse redness, severe pain worse with eye movement, and photophobia
- possible vision impairment
- diffuse erythema and edema with dark red sclera
-elderly
systemic ex. rheum disease common, 50% pts, so refer to rheum
topical and systemic tx: prednisone, immunosuppressants
