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.
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
all of the above
Conjunctival injection is associated with conjunctivitis and other inflammatory conditions of the eye.
poorly visualized optic disc
central visual field loss
Central field loss is associated with macular degeneration.
While arcus senilis may be seen in geriatric patients and is not associated with cataracts.
In retinal detachment the retina is seen hanging in the vitreous like a gray cloud.
In chronic glaucoma there will be slight cupping of the optic disc observed.
Age-related macular degeneration
Findings in age-related macular degeneration include drusen, degenerative changes in retinal pigmentation, and subretinal neovascular membrane changes.