Cataracts

220 Cataracts



Instruction


Examine this patient’s eyes.



Salient features



History




• Drug history (steroids, chloroquine, phenothiazines, chlorambucil, busulfan)


• History of gradual deterioration of vision


• History of diabetes


• Inquire about smoking (JAMA 1992;268:989–94) and alcohol consumption (Arch Ophthalmol 1993;111:1130) as both cigarette smoking and heavy alcohol consumption increase the risk of cataract formation


• Family history is important even in age-related nuclear cataract as it explains about 50% variation in the severity of disease (N Engl J Med 2000;342:1786–90).



Examination




• Bilateral cataracts (shine light obliquely across the lens; Fig. 220.1, see also Fig. 201.3).


image image

Fig. 220.1 Cataracts. (A) Early. (B) White mature cataract.


(With permission from Kumar, Clark 2005.)


Proceed as follows:



• Tell the examiner that you would like to check the urine for sugar.



Diagnosis


This patient has premature bilateral cataracts (lesion) caused by diabetes mellitus (aetiology) and has had a gradual deterioration of vision (functional status).



Questions




Mention a few causes of cataracts




• Common causes:


• Old age (look for arcus senilis). The Framingham study reported that 13% of people aged 65–74 years and about 40% of those over the age of 75 years had cataracts.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Cataracts

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