Cataracts

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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220 Cataracts

Instruction

Examine this patient’s eyes.

Salient features

History

• Drug history (steroids, chloroquine, phenothiazines, chlorambucil, busulfan)

• History of gradual deterioration of vision

• History of diabetes

• Inquire about smoking (JAMA 1992;268:989–94) and alcohol consumption (Arch Ophthalmol 1993;111:1130) as both cigarette smoking and heavy alcohol consumption increase the risk of cataract formation

• Family history is important even in age-related nuclear cataract as it explains about 50% variation in the severity of disease (N Engl J Med 2000;342:1786–90).

Examination

• Bilateral cataracts (shine light obliquely across the lens; Fig. 220.1, see also Fig. 201.3).

image image

Fig. 220.1 Cataracts. (A) Early. (B) White mature cataract.

(With permission from Kumar, Clark 2005.)

Proceed as follows:

• Tell the examiner that you would like to check the urine for sugar.

Diagnosis

This patient has premature bilateral cataracts (lesion) caused by diabetes mellitus (aetiology) and has had a gradual deterioration of vision (functional status).

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