Please enable JavaScript.
Coggle requires JavaScript to display documents.
Other diabetic eye disease (Rubeosis (Diagnosis (History PC/HPC:…
Other diabetic
eye disease
Rubeosis
Clinical presentation
Patient often asymptomatic; may report red vessels on iris
Diagnosis
History
PC/HPC: asymptomatic, acute painful red eye (AACG)
PMH: DM, CVD, previous ocular disease
DH: current meds, allergies
FH: DM, CVD, ocular disease
SH: occupation, driving, smoking, alcohol
Examination
External eye:
red vessels on iris
CN examination:
may have reduced acuity/fields
Fundoscopy:
other signs DM e.g. retinopathy, maculopathy
Investigations
Bedside:
obs (HTN)
Bloods:
FBC, U+E, LFT, glucose, lipids
Imaging:
slit lamp (rubeosis)
Pathophysiology
Microvascular disease of the eye, causing ischemia in the anterior retina and the iris
Increased angiogenic factors e.g. VEGF
Causes dysregulated growth of new vessels
Can blled causing hyphema or glaucoma
Complications
Hyphaema
Glaucoma
Definition
Proliferation of blood vessels on the
iris due to ischemia
Management
Conservative
Information and advice
DM control
Monitoring for complications
Vitreous haemorrhage
Clinical presentation
Sudden, painless loss of vision
Red/black floaters
Diagnosis
Examination
External eye: nil
CN examination: grossly loss acuity and fields
Fundoscopy: no red reflex, blood in vitreous, can't see retina
Investigations
Ocular USS:
identify cause
History
PC/HPC: sudden painless loss of vision, floaters
PMH: CVD, DM, arteritis
DH: current meds, allergies
FH: retinal disease, CVD, DM
SH: pccupation, driving, smoking, alcohol
Pathophysiology
Ischemia causes NVD/NVE
Bleed into vitreous
Management
Conservative
Information, advice, support
Referral to ophthalmology
Surgical
Laser therapy
Vitrectomy
Definition
Bleeding into the vitreous of the eye
Neovascular
glaucoma
Clinical presentation
Aymptomatic
Painful eye (if acute)
Diagnosis
History
PC/HPC: asynptomatic, painful eye
PMH: DM, CVD, other retinal pathology
DH: current meds, allergies
FH: glaucoma, DM
SH: occupation, driving, smoking, alcohol
Examination
External eye: may be red/tender if acute
Fundoscopy: signs of glaucoma
CN examination: often nil
Investigations
Tonometry: high IOP
Goiometry: closed drainage angle
Perimetry: typical glaumoatous field loss
Pathophysiology
Ischemia and angiogenic factor release
Abherrant blood vessel growth
Vessels block the drainage angle of the eye
Causes increased IOP
Management
Conservative
Information and advice
Ophthalmology referral ASAP (if AACG)
Monitoring (fundoscopy, IOP, perimetry, acuity)
Medical
Topical pilocarpine and IV acetazolamide if AACG
Prostaglandin analogues/B-blockers if POAG
Surgical
Trabeculoplasty/trabeculectomy etc.
Definition
Glaucoma due to abherrant blood vessel
formation secondary to DM
Prognosis
Poor
Retinal detachment
Pathophysiology
Haemorrhage, ischemia and fibrosis
Fibrotic scarring contracts, pulling on retina
Clinical presentation
Sudden, painless loss of vision
Grey descending curtain
Flashes and floaters
Definition
Separation of the retinal pigment
epithelium from the retina
Diagnosis
Examination
External eye examination: nil
CN examination: reduced acuity and fields
Fundoscopy: white fibrotic areas, corrugated/folded retina
Investigations
Ocular USS:
identify degree of detachment and cause
History
PC/HPC: sudden loss of vision, curtain, flashes/floaters
PMH: DM, CVD, trauma
DH: current meds, allergies
FH: ocular disease, CVD, DM
SH: occupation, driving, smoking, alcohol
Management
Conservative
Information and advice
Ophthalmology referral ASAP
Surgical
Laser surgery
Vitrectomy
Cataracts
Clinical presentation
Blurry vision, glare from lights
Diagnosis
Examination
External eye:
misty pupil, may be subtle
CN examination:
reduced acuity
Fundoscopy:
reduced red reflex, may have other
signs of DM e.g. retinopathy, maculopathy
Investigations
Slit lamp:
lens opacity, type of cataract
History
PC/HPC: blurred vision, glare
PMH: DM, CVD, ocular disease
DH: current meds, allergies
FH: DM, CV, cataracts
SH: occupation, driving, smoking, alcohol
Pathophysiology
Age-related cataracts accelerated in DM,
lens takes up glucose and converted to sorbitol
Management
Conservative
Information and advice
DM control
Spectacles (reading) and sunglasses
Surgical
Cataract surgery
Definition
Increasing opacity of the lens
of the eye, resulting in blurred vision
CNS eye disease
Horner's syndrome
Miosis, ptosis, anhydrosis
Argyl-Robinson pupil
Bilateral miosis, poor dilatation, irregular pupils,
light-near dissociation (-ve to light, +ve to accomodation)
I.e. 'Prostitutes Pupil' - accomodates but doesn't react
CN palsies
Typically CN III and/or CN IV
In CN III palsy the pupil often spared
(collateral arterial supply)
