Senile cataract

commonest cataract

1. SENILE CATARACT
Ritika Kishore (56)

2. Definition of Cataract
The term “Cataract” refers to the
development of any opacity in the lens
or its capsule.
This leads to decrease vision.

3. Classification
A. ETIOLOGICAL CLASSIFICATION
1.Congenital and Developmental
Cataract , due to formation of opaque
lens fibers.
2.Acquired Cataract, due to
degenerative processes leading to
opacification of normally formed lens
fibers.
 SENILE CATARACT or AGE RELATED
CATARACT

4. Traumatic Cataract
Complicated Cataract
Metabolic Cataract
Electric Cataract
Radiation Cataract
Toxic Cataract
Cataract associated with skin
diseases
Cataract associated with osseous
diseases
Cataract with miscellaneous
syndromes

5. B. MORPHOLOGICAL CLASSIFICATION

6. SENILE CATARACT
It is the most common form of cataract
affecting people of either gender above
50 years of age.
Usually one eye is affected earlier
followed by the other eye.
Morphologically it is of two types:
1.Cortical (soft) Cataract.
2.Nuclear (hard) Cataract

7. The cortical type starts as cuneiform or
cupuliform cataract.
 Both type may co-exist in the same lens.
Cuneiform is predominantly seen, 70%.
ETIOLOGY :
Etiopathogenesis is unclear, but cataract
is essentially an ageing process.

8. Risk Factors
1. Age. Usually seen above 50 years , if it
occurs before 45, the term ‘pre-senile’
cataract is used.
2.Sex. Affects females more, some studies
report.
3.Heredity. Age of onset and maturation is
seen as a genetic trait.
4.UV radiations.
5.Dietary factors.
6.Dehydrational crisis. Like in diarrhea,
cholera, etc.
7.Smoking. Causes accumulation of
pigmented molecules and cyanates
leading to protein denaturation.

9. Cataractogenic Factors
There is a concept that says Cataract
results from multiple sub-threshold
cataractogenic factors.
Age and other toxix stresses such as UV
rays and smoking accelerate the
cataract formation.
Decreased exposure to these factors
have proven to delay cataract
formation.

10. CORTICAL SENILE
CATARACT.
It is the result of decreased levels of total
proteins, amino acids and potassium of
the lens.
There is increased concentration of
sodium and hydration of the lens.
 this ultimately leads to denaturation of
lens proteins.

12. Stages of maturation of
cortical type.
1.Stage of lamellar separation. This can
be seen under slit lamp examination
only, there is demarcation of cortical
fibers, where they start to separate by
fluid
2.Stage of incipient cataract. In this stage
two different forms can be seen.
a.Cuneiform senile cataract . Seen as
wedge shaped opacity with clear
areas in between.

13. These extend from equator towards
center and can be seen when pupils are
dilated.
 First seen in the nasal quadrant.
 these opacities are present both in
anterior and posterior cortex and their
apices slowly progres towards the pupil.
 On oblique illumination, these present as
radical spokes.
On distant direct ophthalmoscopy, these
opacities appear as dark lines agaisnt
red fungal glow.
Visual disturbances are seen in later
stages.

15. b. Cupuliform senile cataract.
 it has a saucer shaped opacity
(postero- subcapsular) which
gradually extend outwards.
 there is usually definitive
demarcation between cataract
and surrounding clear cortex.
This cataract lies in the visual axis,
causes early loss of vision.

16. 3. Immature Senile cataract .
Opacification further progresses in this
stage.
 both forms can be recognized till the
advanced stage of ISC.
 the lens appears greyish white but
clear cortex is present so iris shadow is
visible.
 in some patients, lens swell up due to
hydration, this is called intumescent
cataract, which may persist in next
stage.
The anterior chamber becomes shallow
due to swollen lens.

18. 4. Mature senile cataract. In this stage
opacification becomes complete.
Whole of the cortex is opaque.
Lens become pearly white in colour
Is Also labelled as ‘ripe cataract’

19. 5. Hypermature senile cataract. It develops when
mature cataract is untreated. It is of two types :
Morganian hypermature cataract. The cortex
liquifies and lens becomes a bag of milky fluid.
Small brownish nucleus settles at the bottom,
altering its position with head posture.
 Sclerotic type. The cortex becomes
disintegrated and the lens shrinks due to
leakage of water. The anterior capsule is
wrinkled and thickened due to proliferation of
anterior cells and dense white capsular
cataract may be formed in the pupillary area.
The anterior chamber becomes deep due to
shrinkage of lens.

21. Nuclear Senile Cataract
In this type, the usual degenerative
changes are aggravated due to
dehydration and compaction of nucleus
, leading to hard cataract.
There is increase in water insoluble
proteins, but total proteins remain the
same.
It may be associated with deposition of
pigments like urochrome and melanin.

22. Maturation of Nuclear type
The lens becomes inelastic and hard with
decreased ability to accommodate and
obstructs the light rays.
The changes progress towards the
periphery.
Thin layer of clear cortex is seen when it
matures up to the capsule.
The nucleus becomes cloudy or tinted
due to deposition of pigments.

23. Early nuclear senile cataract

24. Cataracta brunescens
(amber/brown)

25. Cataracta nigra (black)

26. Cataracta rubra (red)

27. Clinical Symptoms
GLARE or intolerance of bright light
UNIOCULAR POLYOPIA i.e. doubling or
trebling or visions due to irregular
refraction by the lens.
COLOURED HALOS owing to the splitting
of light by water droplets in lens.
BLACK SPOTS in front of eyes.
DISTORTION OF IMAGES and blurring.
LOSS OF VISION is painless and gradually
progressive.

28. In cupuliform, there is early loss of vision and
vision is improved when pupils are dilated.
In cuneiform, there is delayed loss and vision is
improved when pupils are contracted.
 Vision diminishes with increased opacification
until only perception of light and projection of
rays remains in the stage of mature cataract.

30. Depiction of iris shadow