Cataract

Cataract refers to development of an opacity due in the lens or its capsule
Due to formation of opaque lens fibre
Due opacification of normally formed transparent lens fibres.

1. CATARACT
PRESENTED BY:-
DHANESHWAR PAL
B.OPTOMETRY 5
th
SEM

PRESENTED TO:-
MS. SHRAVANI REDDY

2. CATARACT
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Cataract refers to development of an
opacity due in the lens or its capsule
Due to formation of opaque lens fibre
Due opacification of normally formed
transparent lens fibres

3. TYPES OF CATARACT
A.
I.
II.
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ETIOLOGICAL CLASSIFICATION :-
Congenital and developemental cataract
Acquired cataract
Senile cataract
Traumatic cataract
Complicated cataract
Metabolic cataract
Electric cataract
Radiational cataract

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ii.
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Toxic cataract
Corticosteriod induced cataract
Miotics induced cataract
Copper and iron induced cataract
Cataract associated with skin diseases
Cataract associated with asseous
diseases
Cataract with miscellaneous syndromes:-
Dystrophica myotonica
Down’s syndrome
Lowe’s syndrome
Treacher-collin’s syndrome

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B. MORPHOLOGICAL CLASSIFICATION:-
Capsular cataract
Anterior capsular cataract
Posterior capsular cataract
Subcapsular cataract
Anterior subcapsular cataract
Posterior subcapsular cataract
Cortical cataract
Supranuclear cataract
Nuclear cataract
Polar cataract
Anterior & Posterior polar cataract

6. CONGENITAL AND DEVELOPEMENTAL
CATARACT
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These occurs due to some disturbance in normal
growth of the lens that is clouding of natural lens
that is present at birth
CAUSES:-
Maternal factors such as drug ingestion ,
metabolic factors , inflammation ,diabetes
Feotal or infantile factors such as deficient
oxygenation , birth trauma , malnutrition in early
infancy

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ii.
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CLINICAL TYPES:-
CONGENITAL CAPSULAR CATARACT-
Anterior capsular cataract- non-axial ,
stationary and visually insignificant
Posterior capsular cataract- associated with
persistent hyaloid artery remnants
POLAR CATARACT-
Anterior polar cataract-occurs due to delayed
development of anterior chamber and due to
corneal perforation
Posterior polar cataract-lens anomaly consist
of small circular opacity including posterior
pole

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i.
ii.
iii.
a)
b)
c)
CONGENITAL NUCLEAR CATARACT :-
Cataracta centralis pulverulenta- it is an
embryonic cataract occurs due to inhibition of
the lens development at early stage
Lamellar cataract- it is a developmental cataract
in which opacity occupies a discrete zone in the
lens
Sutural and axial cataract- consist of series of
punctate opacity around anterior and posterior
y-suture
Floriform cataract-arranged like the petals of a
flower
Coralliform cataract-spindle shaped opacity
Spear-shaped cataract-opacity in the form of
scattered heaps of shining crystalline needles

9. d)
iv.
a)
b)
c)
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developemental and fetal nucleus
characterized by chalky white central opacity
Generalized cataract-
Coronary cataract-opacity of adolescent or
deeper layer of the cortex( periphery of the lens)
in the form regular radial distribution
Blue dot cataract- opacity in the form of bluish
dot situated in periphery of the lens
Total congenital cataract-
Rubella cataract-pearly white ,lens matter
remains soft or liquify
Rubella syndrome-ocular defect cloudy cornea ,
micropthalmus , poorly dilating pupil

10. d)
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Congenital membranous cataract-complete
disappearance of the all lens fibres and only
fine transparent lens capsule remains behind
MANAGEMENT:-
Clinic investigation workup-assesment of ocular
function , associated ocular defect
Laboratory investigations- intrauterine infection ,
hyperglycemia , hypocalcemia
Prognostic factors-density , uni/bilateral,
systemic/ocular defect
Correction of paediatric aphakia-paediatric IOL ;
size ,design , power

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TREATMENT:-
Irrigation and aspiration of lens matter
Lensectomy

12. ACQUIRED CATARACT
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Opacification occurs due to degeneration of
already formed normal fibres
CLINICAL TYPES :-
SENILE CATARACT-Vision impairing disease
caused by age and characterized by gradual
progressive thickening of the lens
CAUSES-
Heredity
Long term exposure to UV rays
Hypertension

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Smoking
Obesity
Longterm usage of coericosteroids
CLINICAL FEATURES-
SYMPTOMS-
Glare
Uniocular polyopia
Coloured halos
Black spot in front of eyes
Loss of vision

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SIGNS-
Immature senile cataract-
Color of the lens-greyish white
Iris shadow-seen
Distant direct opthalmoscope with dilated pupil-
multiple dark areas against fundal glow
Slit lamp examination-areas of normal with
cataractous cortex
Mature senile cataract-
Pearly white with sinking brownish nucleus
Not seen
No red glow due to complete cataract

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Complete cortex is cataractous
Hypermature senile cataract( morganian)-
Milky white
No seen
No red glow milky white pupil
Milky white cortex with sunken brownish nucleus
Hypermature senile cataract ( sclerotic)-
Dirty white with hyper white spot
Not seen
No red glow dirty white pupil
Shrunken cataractous lens with thickened
anterior capsule

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DIAGNOSIS:-
Examination of ocular adnexa and intaoculare
structures
Swinging flashlight tests
Slit lamp examination
Direct and indirect opthalmoscope
COMPLICATIONS:-
Lens induced glaucoma
Subluxation or dislocation of the lens
TREATMENT:-
Lens extraction

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TRAUMATIC CATARACT:-opacification of lens due
various kinds of physical and electrical injury as
well as radiation exposure and due to perforating
and blunt trauma
CAUSES:-
Penetrating trauma
Blunt trauma
Electric shock and lightning strike
Infrared radiation
Ionizing radiation

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CLINICAL FEATURES:-
Blurred vision
Diplopia
Reduced day and night vision
Pupil partially aphakic

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COMPLICATED CATARACT:- occurs due to
disturbance of the nutrition of lens due
inflammatory and degenerative diseases of
anterior and posterior segment of the eye cataract
formation in retinitis pigmentosa , retinal
detachment to secondary glaucoma
CAUSES:-
Iridocyclitis
Retinitis pigmentosa
High myopia
Intraocular tumors
Perforated central corneal ulcer

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CLINICAL FEATURES :-
Total opacity with chalky white appearance
DIAGNOSIS:-
Slit lamp examination
Positive history of ocular and systemic diseases
Ultrasonography
TREATMENT:-
Extra capsular cataract extraction

21. i.
a)
b)
ii.
a)
b)
METABOLIC CATARACT :- occurs due to endocrine
disorders and biochemical abnormalities
Common varieties of metabolic cataract-
Diabetic cataract-
Senile cataract-appears at an age early age and
progresses rapidly
True diabetic cataract-occurring in young adults
due to osmotic over hydration of the lens
Galactosaemic cataract-occurs due inborn error
of galactose metabolism . occurs in two forms
Classical galactosaemic occurs due to
deficiency of galactose-1 phosphate uridyl-
transferase
A related diseases occurs due to deficiency

22. iii.
iv.
v.
Hypocalcaemic (tetanic) cataract-occurs due
to atrophy or parathyroid gland
Cataract due to error of copper metabolism-
inborn error of copper metabolism results in
sunflower cataract, kayser fleischer ring
Cataract in lowe’s syndrome- inborn error of
amino acid metabolism
ELECTRIC CATARACT-occurs after passage of
powerful electric current through the body. The
cataract usually starts as punctate subcapsular
opacities which mature rapidly
the source of current can be a live electricity wire
or a flash of lightning

23. a)
b)
RADIATIONAL CATARACT-occurs due to exposure
to almost all types of radiant energy which
damages the lens epithelium
Infrared cataract- prolonged exposure to
infrared which may cause discoid posterior
subcapsular opacities and true exfoliation of
the anterior capsule
Irradiation cataract-exposure to X- rays , Y-rays
or neutrons
TOXIC CATARACT-caused by exposure to a toxic
substances
corticosteroid induced cataract , miotics induced
cataract, copper and iron induced cataract

24. THANK YOU