Mary 75, presents with gradual deterioration and clouding of her vision over the past few years. She has a history of poorly controlled Type 2 diabetes with Hba1c of 8.5%
What is your primary diagnosis?
- Cataracts
What are the Causes of this presentation?
- Advancing age
- Diabetes
- Drugs incl Steroids as elucidated below
- Radiation – long exposure to UBV
- TORCH organisms
- Trauma
- Uveitis
- Smoking
What classes of medications can precipitate this presentation?
- Corticosteroids
- Antipsychotics part Quetiapine
- Methotrexate
- Oral contraceptives
- Carbamazepine
- Thiazides
What are the key features of history for this presentation?
- Blurry vision/ Difficulty reading
- Glare
- Halos
- Diplopia
- Yellowing of vision
What are the key features of examination in this presentation?
- Unilateral pupil opacity
- Absence of red reflex
- Reduced visual acuity
What are the complications of this presentation?
- Glaucoma
- Uveitis
- Falls
- Visual impairment
- Occupational implications
- Driving implications
What is the Visual Acuity standard for an unrestricted private drivers licence?
- 6/12 in the best eye or both eyes
What is the Visual Acuity standard for an unrestricted commercial drivers licence?
- Better eye at least 6/9 and worse eye at least 6/18
What are the key features of management of this presentation?
- Correction of risk factors
- Referral to ophthalmology for surgery
- Sunlight avoidance with sunglasses or hats
What are the differentials of leukocoria in children?
- Retinoblastoma
- Congenital cataract
- retinal malformation
- retinopathy of prematurity
- retinal detachment
- Intraocular infection
What is the most important immediate step in management in leukocoria in children?
- Immediate referral to ophthalmologist
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