Patient presents as → a 78-year-old man who complains of slowly progressive vision loss over the last several years. He describes his vision as if he is looking through "dirty glass" and reports seeing a white halo around lights. On physical exam, there is clouding of the lens and no red reflex.
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Cataracts are an opacity of the lens that affects the vision and are the leading cause of blindness worldwide
- Risk factors for cataracts include age (usually > 60), smoking, ETOH, sunlight exposure, diabetes, metabolic syndrome, prolonged drug use (esp. glucocorticoids), radiation
- Seen with prolonged systemic or inhaled steroid use and statins
Cataract appears dark against the red reflex on exam
- Slit lamp to magnify, difficult to see the fundus
In the early stages, lifestyle modifications like using glasses, brighter lighting, anti-glare sunglasses, and pupillary dilation (with phenylephrine 2.5% every 4 to 8 hours) can be effective
- Definitive treatment is with cataract removal - Surgery is generally reserved for more severe cases where vision impairment significantly affects daily activities
Cataracts are opacities of the lens that develop gradually over time. These are age-related and are typically painless. When examining patients we see a cloudy, opaque lens, which leads to decreased visual acuity. The definitive treatment for cataracts is surgery.
Play Video + QuizQuestion 1 |
Alcohol | |
Tobacco use | |
Metabolic syndrome | |
Sunlight exposure | |
all of the above |
Question 2 |
conjunctival injection Hint: Conjunctival injection is associated with conjunctivitis and other inflammatory conditions of the eye. | |
poorly visualized optic disc | |
central visual field loss Hint: Central field loss is associated with macular degeneration. | |
arcus senilis Hint: While arcus senilis may be seen in geriatric patients and is not associated with cataracts. |
Question 3 |
Retinal detachment Hint: In retinal detachment the retina is seen hanging in the vitreous like a gray cloud. | |
Chronic glaucoma Hint: In chronic glaucoma there will be slight cupping of the optic disc observed. | |
Age-related macular degeneration Hint: Findings in age-related macular degeneration include drusen, degenerative changes in retinal pigmentation, and subretinal neovascular membrane changes. | |
Cataract |
List |
References: Merck Manual · UpToDate