Tag: Symptoms

SENILE CATARACT- Pathophysiology, Symptoms, Complications

SENILE CATARACT- Pathophysiology, Symptoms, Complications

Q. 1

Which is not a cause for Hamarlopia?

 A

Polar cataract

 B

Congenital deficiency of cones

 C

Peripheral cortical cataract

 D

Central corneal opacity

Q. 1

Which is not a cause for Hamarlopia?

 A

Polar cataract

 B

Congenital deficiency of cones

 C

Peripheral cortical cataract

 D

Central corneal opacity

Ans. C

Explanation:

Peripheral cortical cataract causes Nyctalopia. Central vitreous opacity, Congenital deficiency of cones and Central nuclear or polar cataracts can cause Hamarlopia (Day blindness).

Ref: A K Khurana, 2nd Edition, Page 11.

Q. 2

Which of the following type of cataract is most commonly associated with ageing?

 A

Nuclear cataract

 B

Intumescent cataract

 C

Morgagnian cataract

 D

Posterior subcapsular cataract

Q. 2

Which of the following type of cataract is most commonly associated with ageing?

 A

Nuclear cataract

 B

Intumescent cataract

 C

Morgagnian cataract

 D

Posterior subcapsular cataract

Ans. A

Explanation:

Nuclear cataract is the most common and type and the one most commonly associated with ageing. It consist of a central diffuse opacification and coloration that involve the lens nucleus.
  • Intumescent cataract is a form of cortical cataract where the nucleus is white and the capsular bag is swollen because of fluid absorption. 
  • Morgagnian cataract is a hypermature cataract in which entire lens capsule is wrinkled and total liquefaction of the cortex allows the nucleus to move freely in the bag and sink inferiorly due to effects of gravity.
Ref: Cataract Surgery from Routine to Complex: A Practical Guide By George J. C. Jin, page 21.

Q. 3

Which type of senile cataract is notorious for glaucoma formation?

 A

Incipient cataract

 B

Hypermature morgagni

 C

Intumescent cataract

 D

Nuclear cataract

Q. 3

Which type of senile cataract is notorious for glaucoma formation?

 A

Incipient cataract

 B

Hypermature morgagni

 C

Intumescent cataract

 D

Nuclear cataract

Ans. C

Explanation:

In intumescent cataract, the lens may take up fluid during cataractous change, increasing markedly in size. It may then encroach upon the anterior chamber, producing both pupillary block and angle crowding and resulting in acute angle closure. Treatment consists of lens extraction once the intraocular pressure has been controlled medically.
 
Ref: Salmon J.F. (2011). Chapter 11. Glaucoma. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e.

 

Quiz In Between


Q. 4

Steroid induced cataract is

 A

Posterior subcapsular cataract

 B

Anterior subcapsular cataract

 C

Nuclear cataract

 D

Cupulliform cataract

Q. 4

Steroid induced cataract is

 A

Posterior subcapsular cataract

 B

Anterior subcapsular cataract

 C

Nuclear cataract

 D

Cupulliform cataract

Ans. A

Explanation:

A i.e. Posterior subcapsular cataract 

Steroid induced lens opacities are posterior subcapsularQ. Whereas anterior polar cataract is caused by perforating cornea/ injuriesQ.


Q. 5

Good vision in dim light and clumsy in day lights seen in:

 A

Cortical cataract

 B

Morgagnian cataract

 C

Nuclear cataract

 D

a and c

Q. 5

Good vision in dim light and clumsy in day lights seen in:

 A

Cortical cataract

 B

Morgagnian cataract

 C

Nuclear cataract

 D

a and c

Ans. D

Explanation:

A. Cortical cataract; C. i.e. Nuclear cataract

  • In nuclear cataract opacity is central so the vision is poor in daytime (due to miosis) & good in dim light (due to mydriasis) Q
  • Patients with central opacities (eg. cupuliform cataract) see better when the pupil is dilated due to dim light in the evening(day blindness)-Khurana, p192
  • Cupuliform cataract is a type of cortical cataract-Parsons, p253
  • In nuclear cataract opacity is central so the vision is poor in daytime (due to miosis) & good in dim light (due to mydriasis)-Neema, p204
  • Loss of ability to see in broad daylight, blinding due to oncoming headlights while driving are features of posterior sub-capsular cataract (Steroid induced cataract)-Parsons’, p 251(t)

 

Symptom

Pathogenesis

Condition

Reduced visual acuity usually

gradual, painless, progressive

Reduction in transparency of the lens

All types of cataract

Visual field loss

Generalized reduction in sensitivity

due to loss of transparency

All types of cataract

Frequent change of glassesQ

Rapid change in refractive index of

Cortical or nuclear

 

the lens

cataractQ

Monocular diplopia or

Cortical spoke opacities in

Cortical cataract

polyopiaQ

conjunction with water clefts that

form radial wedges containing a fluid

of m lower refractive index than the

surrounding lens

(spoke or cuneiform)

Colour shift (becomes more

Blue end of the spectrum is absorbed

Cortical cataract

obvious after surgery)

more by the cataractous lens

 

Glare

Increased scattering of light

Cortical and posterior

subcapsular cataract

Loss of ability to see objects in

Loss of contrast sensitivity, which is

Posterior subcapsular

bright sunlight, blinded by

greater at higher spatial frequencies;

cataract

light of oncoming headlamps

constriction of pupil cuts off

 

when driving at night

peripheral vision from non‑

cataractous area

 

‘Second sight’ or myopic shift

Change in refractive index of the

nucleus causes index myopia,

improving near vision

Nuclear cataractQ

Coloured halos around light

Irregularity in the refractive index of

different parts of the lens

Nuclear cataract

Fluctuation of refractory error

High level of aqueous glucose is

metabolized by aldose reductaseQ into

sorbitol which then accumulates with

in lens resulting in secondary osmotic

over hydration of lens. Hypeglycemia

leads to fluctuating myopia

Diabetic cataractQ

Shield like cataract

May also result in a Posterior

subcapsular cataract resembling a

complicated cataract

A topic dermatitisQ

Frequent change of presbyopic

Early non-specific complaint

Open angle glaucoma

glasses

 

Q


Q. 6

Polychromatic Lustre is seen in

 A

Posterior cortical cataract

 B

Zonular cataract

 C

Cuppliform cataract

 D

Posterior subcapsular

Q. 6

Polychromatic Lustre is seen in

 A

Posterior cortical cataract

 B

Zonular cataract

 C

Cuppliform cataract

 D

Posterior subcapsular

Ans. A

Explanation:

A i.e. Posterior cortical cataract

Quiz In Between


Q. 7

Polyopia is a symptom of:

 A

Cortical cataract

 B

Cupuliform cataract

 C

Radiational cataract

 D

Electrical cataract

Q. 7

Polyopia is a symptom of:

 A

Cortical cataract

 B

Cupuliform cataract

 C

Radiational cataract

 D

Electrical cataract

Ans. A

Explanation:

Ans. Cortical cataract


Q. 8

In a patient, highest visual morbidity is seen in:

 A

Nuclear cataract

 B

Intumescent cataract

 C

Posterior subcapsular cataract

 D

Anterior subcapsular cataract

Q. 8

In a patient, highest visual morbidity is seen in:

 A

Nuclear cataract

 B

Intumescent cataract

 C

Posterior subcapsular cataract

 D

Anterior subcapsular cataract

Ans. C

Explanation:

Ans. Posterior subcapsular cataract


Q. 9

Most visually handicapping cataract is:

 A

Rosette cataract

 B

Nuclear cataract

 C

Posterior subcapsular cataract

 D

Cortical cataract

Q. 9

Most visually handicapping cataract is:

 A

Rosette cataract

 B

Nuclear cataract

 C

Posterior subcapsular cataract

 D

Cortical cataract

Ans. C

Explanation:

Ans: C i.e. Posterior subcapsular cataract

Reduced visual acuity (gradual, painless, progressive) & visual field loss are manifestations of all types of cataracts

Cataracts & their effects

  • Nuclear cataract manifest as colour shift (more obvious after surgery), second sight/ myopic shift, frequent change of glasses etc.
  • Loss of ability to see objects in bright sunlight, blinding by light of oncoming headlamps when driving at night or glare may be the symptom of posterior subcapsular cataract
  • Cortical cataract may manifest as frequent change of glasses, monocular diplopia/ polyopia, glare or coloured halos around light

Quiz In Between


Q. 10

Second sight phenomenon is seen in:

 A

Nuclear cataract

 B

Cortical cataract

 C

Senile cataract

 D

Iridocyclitis

Q. 10

Second sight phenomenon is seen in:

 A

Nuclear cataract

 B

Cortical cataract

 C

Senile cataract

 D

Iridocyclitis

Ans. A

Explanation:

Ans. A i.e. Nuclear cataract

Symptoms of nuclear cataract

  • Blurring of distance more than near vision (typically, but others may notice worsening of reading more than distance
  • Increasing myopia (“Second-sight” phenomenon of improved uncorrected distance vision in hyperopes and improved uncorrected near vision in emetropes
  • Poor vision in dark settings such as night driving
  • Decreased contrast and decreased ability to discern colors
  • Glare
  • Monocular diplopia

Q. 11

In senile nuclear cataract what type of myopia is seen‑

 A

Curvature myopia 

 B

Index myopia

 C

Axial myopia

 D

Positional myopia

Q. 11

In senile nuclear cataract what type of myopia is seen‑

 A

Curvature myopia 

 B

Index myopia

 C

Axial myopia

 D

Positional myopia

Ans. B

Explanation:

Ans. is ‘b’ i.e., Index myopia

  • Nuclear changes of aging induce a modification of refractive index of lens and produce an index myopia.
  • “Nuclear cataracts cause a general decrease in the transperancy of the lens nucleus.They are associated

withindexmyopia”                                                                                                  — Ophthalmic study guide

Causes of errors of refraction

  • Possible causes of ametropia are : ‑

1) Axial

  • It is the commonest form of ametropia (both myopia and hypermetropia). In hypermetropia, there is an axial shortening of eyeball. So, image is formed behind the retina. In myopia, there is an axial lengthening of eyeball. So, image is formed in front of the retina. 1 mm change in axial length leads to ametropia of 3D. For example 1 mm shortening in axial length causes hypermetropia of 3D.

2) Curvature

  • Change in the curvature of cornea or lens will cause ametropia. In hypermetropia, the curvature of cornea or lens is lesser than normal. In myopia, there is increase in curvature of cornea or lens./ mm change in corneal curvature leads to 6-7 D ametropia.

3) Index

  • If refractive index of optical system is low, it will result in hypermetropia and high refractive index will result in myopia.

4) Positional (Due to relative position of the lens),

  • A forward shift of lens causes myopia, backward shift result in hypermetropia. Absence of lens (aphakia) causes hypermetropia.

5) Excessive accommodation

  • Excessive accommodation due to spasm of accommodation causes myopia.

Quiz In Between



SENILE CATARACT- Pathophysiology, Symptoms, Complications

SENILE CATARACT- Pathophysiology, Symptoms, Complications


PATHOPHYSIOLOGY OF SENILE CATARACT

  • Pathophysiology of loss of transparency of lens is different for nuclear & cortical senile cataract:

A) Cortical senile cataract:

The main biochemical features are:

  1. Decreased levels of total protein, amino acids & potassium.
  2. Increased concentration of sodium & marked hydration of lens.
  3. Coagulation & denaturation of lens proteins

B) Nuclear senile cataract:

  • Usual degenerative changes are intensification of the age related nuclear sclerosis.
  • Associated with dehydration & compaction of the nucleus resulting in a hard cataract.
SYMPTOMS OF SENILE CATARACT
 

SYMPTOMS

CONDITIONS

Visual field loss All types of cataract
Frequent change of glasses Cortical or nuclear cataract
Monocular diplopia or polyopia Cortical cataract (Incipient stage)      (spoke or cuneiform)
Colour shift (becomes more obvious after surgery) Cortical cataract
Glare Cortical & posterior subcapsular cataract
Loss of ability to see objects in bright sunlight, blinded by light of oncoming headlamps when driving at night. Posterior subcapsular cataract

Nuclear cataract

‘Second sight’ or myopic shift

(change in refractive index of the nucleus causes index myopia improving near vision)

Nuclear cataract
Index myopia Nuclear cataract
Index Hypermetropia Cortical cataract

COMPLICATIONS OF SENILE CATARACT

1. Lens induced Glaucoma: Cataract can give rise to secondary glaucoma in following ways:

i) Phacomorphic glaucoma:

  • Lens may swell up by absorbing fluid resulting in shallow anterior chamber (intumescent cataract).
  • Most common type of lens induced glaucoma.
  • Beside intumescent stage of senile cataract, phacomorphic glaucoma is also seen in anterior subluxation/dislocation of lens & spherophakia (congenital small spherical lens).

ii) Phacolytic glaucoma: 

  • In hypermature stage the lens proteins leak out into the anterior chamber & engulfed by macrophages.
  • A type of secondary open angle glaucoma.

iii) Phacotopic glaucoma:

  • Hypermature lens subluxation/ dislocation may cause glaucoma by blocking the pupil or angle of anterior chamber. 

2. Lens induced Uveitis

3. Subluxation or Dislocation of Lens

  • In stage of of hypermaturity the zonules of the lens may weaken & break.
  • This leads to subluxation of the lens or dislocation.

Exam Important

  • Intumescent cataract is the most common type of lens induced glaucoma.
  • Visual deterioration due to senile cataract is painless and gradually progressive in nature.
  • Second sight phenomenon is seen in Nuclear cataract.
  • Polyopia is a symptom of Cortical cataract.
  • Most visually handicapping cataract is Posterior subcapsular cataract.
  • Highest visual morbidity is seen in Posterior subcapsular cataract.
  • Steroid induced cataract is Posterior subcapsular cataract.
  • Nuclear cataract is most commonly associated with ageing.
  • In senile nuclear cataract Index myopia  is seen.
  • Polychromatic Lustre is seen in Posterior cortical cataract.
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