Cataracts
Background
- Opacification of the lens of one or both eyes, which can lead to decreased visual acuity and visual distortions
- Most commonly due to normal age related changes, however they can also be caused by eye trauma, exposure to sunlight or radiation, malnutrition, corticosteroid use, and other pathologic processes
- By age 80, approximately 50% of Americans have been diagnosed with one or more cataracts[1]
- Additional risk factors for cataract include diabetes, smoking, prolonged exposure to sunlight, and alcohol use[2][3]
- Typically a non-emergent pathology and can be managed with outpatient ophthalmologic surgery on a routine basis.
- With the exception of traumatic cataract, vision loss from cataract is typically not acute; rather, develops over the course of months to years.
Clinical Features
- Vision loss typically not acute but develops over months to years (unless traumatic cataract)
History
- Cloudy or blurry vision
- Difficulty with night time vision
- Colors appear faded
- Appearance of a halo around bright lights
- +/- Recent trauma to the eye
Exam Findings
- Lens opacity
- Darkening of red reflex
- Decreased visual acuity
Differential Diagnosis
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Subacute Vision Loss (Noninflamed)
- Cataracts
- Congenital blindness
- Diabetic retinopathy
Orbital trauma
Acute
- Caustic keratoconjunctivitis^^
- Conjunctival hemorrhage
- Conjunctival laceration
- Corneal abrasion, Corneal laceration
- Globe rupture^
- Iridodialysis
- Lens dislocation
- Ocular foreign body
- Orbital fracture
- Frontal sinus fracture
- Naso-ethmoid fracture
- Inferior orbial wall fracture
- Medial orbital wall fracture
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage/hematoma
- Subconjunctival hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
Subacute/Delayed
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Typically diagnosed clinically by the finding of lens opacity on direct ophthalmic exam
- Precise classification (nuclear, cortical, posterior sub-capsular) may be done by ophthalmologist
- If the patient has risk factors for diabetes or HIV/AIDS, consider appropriate diagnostic tests
Management
- Definitive treatment is (typically outpatient, non-emergent) surgery, wherein clouded lens is removed and replaced with clear, artificial lens
- Other supportive care modalities that help with visual symptoms include:[4]
- Using brighter lights while at work or at home
- A trial of anti-glare sunglasses for outdoor activities
- Using magnifying lens glasses for reading and other daily
Disposition
- Discharge with optho follow up
See Also
External Links
- https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts
- https://www.aao.org/young-ophthalmologists/yo-info/article/how-to-conduct-eight-point-ophthalmology-exam
References
- ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
- ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
- ↑ West SK, and Valmadrid CT, "Epidemiology of risk factors for age-related cataract," Surv Ophthalmol. 1995;39(4):323.
- ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020