Powerpoint presentation on Geriatric ophthalmology. It covers vast topic of eye disorder in elderly

1. GERIATRIC
OPHTHALMOLOGY
Dr. ARVIND CHAUHAN
PROF & HEAD
DEPT. OF OPHTHALMOLOGY

3.  ‘Senior citizen’ or ‘Elderly’ as a person who
is of age 60 years or above.
 Geriatrics or Geriatric Medicine:
 specialty that focuses on health care of elderly people
 aims to promote health by preventing and treating
diseases and disabilities in older adults
 The elderly population (aged 60 years or
above) account for 7.4% of total population in
2001.
GERIATRICS

4.  About 64 per thousand elderly persons in rural
areas and 55 per thousand in urban areas suffer
from one or more disabilities.
 Most common- Loco motor disability 3%
 Hearing disability 1.5%
 Blindness (1.7% in rural areas, and 1% in urban
areas)
HEALTH PROBLEMS IN OLD PERSONS

5. PROBLEM STATEMENT
 Visual impairment is important health problem in
elderly.
 With advancing age normal visual function
decreases and there is increase in ocular
pathology.
 Untreated visual disturbance lead to increased
incidence of falls, depression , social isolation and
dependency.
 Active screening for visual impairment should be a
part of health examination.
 Elderly should have visual assessment 1-2 yearly
for early detection and prevention of permanent
visual impairment.

6.  The m/c causes:
 Age-related Cataract 52%
 ARMD NonExudative -25% Exudative -5%
 Glaucoma 2-10%
 Diabetic Retinopathy.
Incidence rates increase with increasing age.
According to WHO
 Visual impairment <6/18-6/60
 Severe visual Impairment <6/60-3/60
 Blind <3/60-1/60
VISUAL IMPAIRMENT

7.  Loss of transparency of Optical Media like :
 Cornea-Ulcer / Scar / Opacity / Degeneration
/Dystrophy/ Dry EYE
 Lens- Cataract / Dislocation/ Subluxation
 Vitreous-Degeneration/Haemorrhage
 Retinal Layers-DR / ARMD / HTN
 Loss of Normal Architecture- DR / Glaucoma /
ARMD
 High Refractive Errors-Myopia /Hyperopia
 Presbyopia
VISUAL IMPAIRMENT IS DUE ANY OF THE
FOLLOWING CAUSES:

8.  Other than Blindness
 Ocular Surface Diseases:
 Blepharitis
 Entropion /Ectropion
 Pterygium
 Dry Eye
 Corneal Ulcer or Keratitis
 Corneal Degeneration
 Corneal Dystrophy
OPHTHALMOLOGICAL PROBLEMS IN ELDERLY

9. OPHTHALMIC EXAMINATION
 Demographic Data
 History
 Systemic illness H/o
 Drug H/O
 Detailed Eye Examination
 Visual acuity
 IOP
 Detailed Fundus Examination
 Investigations

10. XANTHELESMMA
 They are creamy yellow
lipid deposit near the
medial canthus at upper
or lower eyelid.
 They represent lipid
deposit in histiocytes in
dermis of skin of lids.
 Mostly seen in middle
aged women
 Associated with Diabetes
and High cholesterol
level

11. ENTROPION
 Inward turning of eyelid
margin
 Symptoms due to
trichiasis – rubbing of
eyelashes on cornea and
conjunctiva leads to FB
sensation,
 Photophobia, Pain and
lacrimation.
 It can be Cicatrical
 Spastic
 Senile / Involutional
 Mechanical

12. ECTROPION
 Outward turning of eyelid
margin
 Epiphora is the main
complaint
 Mild photophobia and
irritation due to chronic
conjunctivitis
 It can be Cicatrical
 Senile
 Paralytic
 Spastic
 Mechanical

13. PTERYGIUM
 It is triangular
encroachment of
vascularized
granulation tissue
covered by conjunctiva
in interpalpeberal area.
 Bilateral, nasal induce
astigmatism
 Treatment : Excision
with autograft

14. ARCUS SENILIS
 Bilateral
 Superior and inferior
quadrant.
 Annular ring of lipid
infiltration at corneal
periphery.

15. CORNEAL ULCER
 Infection of cornea due to
organism causing necrosis
and pus.
 Symptom : Pain , lacrimation,
photophobia, blurring of vision,
redness
 Treatment: Antibiotics topical ,
Homatropine,

16. HERPES SIMPLEX KERATITIS
 Infection of cornea with
Herpes simplex virus.
 Skin lesions associated
with corneal punctate/
stromal keratitis.
 Pain, photophobia,
lacrimation
 Treatment : Antiviral

17. CORNEAL BLINDNESS
 In elderly corneal
degeneration and
dystrophy are common
which leads to corneal
opacity and scarring.
 Treatment :
Keratoplasty

18. STEPS OF PENETRATING KERATOPLASTY

21. DRY EYE
 Dry Eye occurs due to
inadequate tear film or
function resulting in
unstable tear film and
ocular surface disease.
 MC symptoms dryness,
grittiness, and burning
sensation,. Stringy
discharge , transient
blurring of vision

23. PRESBYOPIA
 Caused due to hardening or
sclerosis of the lens substance, or
loss of ciliary muscle and choroidal
elasticity.
 The lens gradually becomes thicker
and loses its flexibility over time
resulting in failure to accommodate
light from objects of various
distances.
 Difficulty in near vision…reading
fine prints.
 Treatment : Spectacles

24. CATARACT
 Leading cause of vision loss in elderly
Three distinct types of cataract are seen
clinically according to the anatomical area of
opacity:
 (1) Nuclear sclerotic cataracts are associated with
central lens opacification,
 (2) Cortical cataracts consist of radial spokes
extending from the periphery and
 (3) Posterior subcapsular cataracts are located in
the posterior cortical layer and often involve
the central visual axis.

26.  Symptoms : foggy, blurred vision
 colour perception may also be affected.
 Driving at night may be difficult as
 they experience glare from oncoming headlights
especially for those with posterior subcapsular
cataract.
 If a patient has an associated refractive error,
double vision in one eye or monocular diplopia may
be a feature.

29. CATARACT….
Nuclear Cortical
Posterior
SubCapsular
Anterior
SubCapsular

30. Classification according to maturity
Immature Mature
Hypermature Morgagnian

31.  TREATMENT
 Modern cataract surgery is very safe and
can be performed as an outpatient procedure under
local anaesthesia.
 The techniques commonly applied are
extracapsular cataract extraction and
phacoemulsification with intraocular lens
implantation.

33. GLAUCOMA
 Glaucoma is defined as progressive optic
neuropathy resulting in a characterstic appearance
of the optic disc and a specific pattern of
irreversible visual field defects that are associated
frequently but not invariably with raised intraocular
pressure (IOP).
 Prevalence is about 3-4% in patients above 70 yrs.
 Significant cause of blindness in the world

37.  Pathogenesis : There is obstruction to aqueous
outflow at trabecular meshwork.
 It results in increased IOP which causes
mechanical damage to retinal ganglion cells
 Raised IOP causes microcirculation stasis which
leads to impairment of nutrients and gluatamate
toxicity.

39.  Symptoms in POAG is headache, eyeache,
 Visual field defect - peripheral loss of vision
 Frequent changes in presbyopic glasses
 Delayed Dark adaptation
 PACG – Acute red eye.
 Pain , severe headache, redness , blurred vision ,
colored halos, raised IOP due to angle closure seen
on Gonioscopy.

40. NORMAL OPTIC DISC

41. EARLY GLAUCOMATOUS DISC

42. ADVANCED GLAUCOMATOUS OPTIC DISC

43. VISUAL FIELD DEFECTS IN GLAUCOMA

45. INTRAOCULAR PRESSURE
 Normal range 11- 21 mmHg
 It is measured using Tonometer
It is only modifiable factor. Therefore all treatment
modalities are based on controlling IOP.

46. TREATMENT OF GLAUCOMA
 Medical
 Topical :
 1. Beta blockers
 2. Carbonic anhydrase
inhibitor
 3. Alpha 2 agonist
 4. Prostaglandin
analogue
 5. Pilocarpine
 Syestemic:
 Mannitol20% IV
 Acetazolamide
 Surgical
 Argon Laser
trabeculoplasty
 Filtering surgery

47. DIABETIC RETINOPATHY
 Changes in retina due to high blood sugar level.
 Most important associated with duration of
Diabetes.
 MC cause of visual loss in patients with Diabetes
Two types of DR
 Non proliferative DR
 Proliferative DR

50. Mild NPDR Moderate NPDR
Severe NPDR Very Severe NPDR

52. Moderate PDR Severe PDR
Diabetic Maculopathy

53. HYPERTENSIVE RETINOPATHY
 Refers to fundus changes occuring due to Hypertension.
 Grading of hypertensive retinopathy
 Keith and Wegner (1939)
 Grade I It consists of mild generalized arteriolar attenuation, particularly of small branches,
with broadening of the arteriolar light reflex and vein concealment.
 Grade II : It comprises marked generalized narrowing and focal attenuation of
arterioles associated with deflection of veins at arteriovenous crossings
 Grade III : Grade II changes plus copper-wiring of arterioles, banking
of veins distal to arteriovenous crossings , tapering of veins on either side of the crossings
and right-angle deflection of veins . Flame-shaped haemorrhages, cotton-wool spots and
hard exudates are also present.
 Grade IV : Grade III chnages plus silver-wiring of arterioles
and papilledema

54. Grade 1 HTN R Grade2 HTN R
Grade 3 HTN R Grade 4 HTN R

55. AGE RELATED MACULAR
DEGENERATION
 Blindness > 60 yrs of age
 Bilateral
 Two types :
 Dry ARMD
 Wet ARMD
 Symptoms : Central visual field defect,
metamorphosia or distorted images.
 Treatment : Laser photocoagulation
 Photodynamic therapy

57. DRY ARMD WET ARMD

59. BASAL CELL CARCINOMA
 Commonest malignant
tumor of eyelid.
 Locally invasive tumor
 Mc lower lid > Medial
canthus > Upper lid > lateral
canthus
 Nodule with pearly rolled
out margins.
 Tumor grows by burrowing
the local tissue hence
rodent ulcer.
 Treatment : Surgical wide
excision with reconstructon

60. SQUAMOUS CELL CARCINOMA
 Second MC malignant
tumor
 Arise from eyelid
margin
 Ulcerated growth with
elevated and indurated
margins.
 Metastasis to
submandibular LN
 Treatment : Wide
excision with surgical
reconstruction

61. SEBACEOUS CELL CARCINOMA
 Tumour arising from
meibomian gland.
 Mostly in upper lid
 Mimic as chalazion
 Metastasis common
 Treatment : Wide
excision with lid
reconstruction

62. MALIGNANT MELANOMA
 Rare malignant tumor
 Arise from pre exisiting
nevus or de novo from
melanocytes of skin.
 It appears as flat or raised
nevus with variegated
pigmentation irregular
border which ulcerate and
bleeds .
 Metastasis via lymphatics
and blood stream.
 Treatment : Surgical
excision with reconstruction