• any opacity of crystalline lens
• types
  • cortical
  • nuclear sclerotic
  • posterior subcapsular
  • traumatic
  • congenital

LEADING CAUSE OF REVERSIBLE BLIDNESS WORLDWIDE

• anterior
  • exaggeration of normal nuclear aging change
  • causes increasing myopia
• posterior view
  • increasing nuclear opacification
  • initially yellow than brown

• anterior- initially vacuoles and clefts
• posterior- progressive radial spoke like opacities

• ant.- polychromatic needle like opacities (red green)
• post.- may co exist with other opacities

• symptoms
  • decrease vision
  • glare
  • inability to perform activities of daily living safely
  • trouble with small print when reading
• treatment
  • surgery
  • no medical prevention

• most common surgical procedure in US
• very successful
• outpatient
• almost all with intraocular lens
• most successful surgical intervention
• complication- uncommon, sight threatening

1. anterior capsulotomy
2. completion of incision
3. expression of nucleus
4. cortical cleanup
5. care not to aspirate post. capsule accidentally
6. polish post. capsule, if appropriate
7. injection of viscoelastic substance
8. grasping of IOL and coating with viscoelastic substance
9. insertion of inferior haptic and optic
10. insertion of superior hepatic
11. placement of hepatic into capsular bag not into cillar sulcus
12. dialling of IOL, into horizontal position

1. capsulorrhexis
2. hydrodissection
3. sculpting of nucleus
4. cracking of nucleus
5. emulsification of each quadrant
6. cortical cleanup and insertion of IOL

• char
  • subtype of optic neuropathy
• type
  • open angle
  • angle closure
• pathology
  • peripheral arcuate visual field defects (late loss of central vision)
  • optic nerve had cupping
  • usually with elevated intraocular pressure

• ciliary body makes aqueous humor
• flows past the lens, around the irus, through the trabecular meshwork (TM), then canal of Schlemm at corneal schleral junction
• drains into venous circulation
• so if the drain is not working, you make too much aqueous humor fluid, this will cause pressure increase

• open angle
  • TM function poorly
  • multiple etiology
• angle closure
  • iris block TM
  • multiple etiology

• increased intraocular pressure
• optic N. cupping
  • loss of retinal NFL leads to increase in cup in center of nerve
• visual field defects
  • usually arcs in peripheral visual fields
  • advance without treatment
• asymptomatic

• reduce IOP
  • topical drops
    • lower prod. of aqueous
    • increase outflow
  • laser treatment of TM
    • increase outflow
  • surgery
    • trabeculectomy with creation of filtering bleb
    • valve implant with creation of filtering bleb

• pain
• decrease vision
• photophobia
• halos/glare
• headache
• nausea/emesis
• cloudy cornea
• mid dilated pupil
• ciliary flush

USUALLY ACUTE AND VERY HIGH IOP

• EMERGENCY
• topic drains
• oral CA inh.
• IV mannitol
• laser iris- peripheral iridotomy