Senile Cataracts: Types, Causes, and Development
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Questions and Answers

In cortical senile cataracts, what changes contribute to the loss of lens transparency?

  • Decreased sodium concentration and decreased crystallin levels.
  • Decreased crystallin levels and increased sodium concentration. (correct)
  • Increased crystallin and sodium levels only
  • Increased crystallin levels and decreased sodium concentration

What is the earliest sign of a senile cataract of the cortical type?

  • Hardening of the lens nucleus
  • Formation of vacuoles and water clefts in the anterior and posterior cortex. (correct)
  • Displacement of the lens from its original position
  • Complete opacification of the lens cortex

What is the key characteristic of an immature senile cataract (IMSC)?

  • The lens remains completely transparent
  • The posterior subcapsular area remains clear
  • Reversal of initial changes with complete restoration of transparency
  • The lens appears greyish white due to complete opacification of the cortex. (correct)

What happens to the lens in a Morgagnian hypermature cataract?

<p>The lens dissolves into a milky fluid, settles at the bottom of the lens capsule, and changes position. (B)</p> Signup and view all the answers

What initiates the hydration of lens fibers in cortical senile cataracts?

<p>Decrease in the function of active transport pump mechanism of ions. (A)</p> Signup and view all the answers

How does nuclear sclerotic cataract affect the lens?

<p>The lens becomes firm and hard, reducing its ability to accommodate. (D)</p> Signup and view all the answers

What is the role of deamination of lens proteins in the development of cataracts?

<p>Reversing the normal $Na/K$ ratio, leading to hydration and loss of transparency. (B)</p> Signup and view all the answers

In the context of senile cataracts, what is the consequence of decreased synthesis of proteins in lens fibres?

<p>Decreases amino acid levels and reduces oxidative reactions, affecting lens transparency. (C)</p> Signup and view all the answers

Which factor is least likely to influence the development and progression of senile cataracts?

<p>Sustained periods of elevated blood glucose levels. (A)</p> Signup and view all the answers

A 40-year-old patient presents with posterior subcapsular cataract. Considering the etiology of pre-senile cataracts, which of the following conditions is most likely associated with this specific type of cataract in this age group?

<p>Presence of myotonic dystrophy. (A)</p> Signup and view all the answers

How does smoking contribute to the formation of nuclear cataracts based on the information presented?

<p>By facilitating the accumulation of pigmented molecules such as 3-hydroxykynurenine. (D)</p> Signup and view all the answers

In comparing the prevalence of senile cataracts between genders, what trend is most frequently observed?

<p>Females exhibit a consistently higher prevalence of cataracts compared to males at all ages. (D)</p> Signup and view all the answers

Which scenario would most strongly suggest the presence of a pre-senile cataract rather than a senile cataract?

<p>A 42-year-old female with rapidly progressing posterior subcapsular opacities. (A)</p> Signup and view all the answers

Given that UV irradiation is a risk factor for cataracts, which preventative measure would be most effective in reducing this risk?

<p>Wearing sunglasses that block UV rays. (B)</p> Signup and view all the answers

A researcher is studying the impact of dietary factors on cataract development. Which combination of dietary deficiencies would be most likely to correlate with an increased risk of early-onset senile cataract?

<p>Deficiency in riboflavin, vitamin A, C, and E, combined with low protein and amino acid intake. (B)</p> Signup and view all the answers

A patient experienced a severe dehydrational crisis in childhood due to cholera. How might this early-life event potentially influence cataract development later in life?

<p>By potentially affecting the age of onset and maturation of senile cataract. (B)</p> Signup and view all the answers

A patient presents with a lens exhibiting a milky white appearance and shiny spots. Direct ophthalmoscopy reveals no red glow. Which stage of senile cataract is most consistent with these findings?

<p>Hypermature Senile Cataract (Sclerotic) HMSC (S) (B)</p> Signup and view all the answers

Which of the following slit-lamp biomicroscopy findings is most indicative of a Grade IV nucleus hardness?

<p>Brownish nucleus (B)</p> Signup and view all the answers

In phacolytic glaucoma, which mechanism directly leads to an increase in intraocular pressure (IOP)?

<p>Blockage of the trabecular meshwork by macrophages that have engulfed leaked lens proteins (B)</p> Signup and view all the answers

A patient diagnosed with phacomorphic glaucoma secondary to an intumescent lens is most likely to exhibit which type of angle closure?

<p>Secondary angle closure (D)</p> Signup and view all the answers

Which of the following is the most likely refractive change observed in a patient with developing nuclear sclerosis?

<p>Myopia due to increased refractive index of the nucleus (B)</p> Signup and view all the answers

During slit-lamp examination of a patient with an incomplete senile cataract (ISC), what distinguishing characteristic would differentiate it from a normal lens?

<p>Presence of multiple dark areas against a red fundal glow during direct ophthalmoscopy (C)</p> Signup and view all the answers

In which stage of cataract development would you expect to observe an iris shadow upon examination?

<p>Incomplete Senile Cataract (ISC) (D)</p> Signup and view all the answers

A patient presents with signs of phacoanaphylactic uveitis. Which of the following cataract types is most likely the underlying cause?

<p>Hypermature cataract (D)</p> Signup and view all the answers

Which of the following best explains why retinoscopy is typically not possible in cases of mature senile cataract (MSC)?

<p>The complete opacification of the cortex prevents light from reaching the retina. (D)</p> Signup and view all the answers

A patient has a mature senile cataract. Which of the following is the most important differential diagnosis to exclude?

<p>Retrolenticular causes of leukocoria (C)</p> Signup and view all the answers

A patient reports experiencing glare and halos around lights, but their visual acuity is still relatively good. What is the MOST likely type and stage of cataract they are experiencing?

<p>Incipient cortical cataract, causing irregular refraction but not yet severe vision loss. (D)</p> Signup and view all the answers

Why does posterior subcapsular cataract (PSC) often lead to early and significant vision loss compared to other types of cataracts?

<p>PSC is located at the nodal point of the eye, directly impacting light transmission. (B)</p> Signup and view all the answers

In the context of cataract development, what is 'second sight,' and which type of cataract is it MOST commonly associated with?

<p>Improved near vision due to progressive index myopia, associated with nuclear sclerosis. (A)</p> Signup and view all the answers

During an eye examination, an ophthalmologist shines an oblique beam of light on a patient's pupil and observes a crescent-shaped shadow on the iris. What does this observation indicate about the patient's cataract?

<p>The shadow suggests an immature cataract with some clear cortex remaining. (A)</p> Signup and view all the answers

A patient diagnosed with a cuneiform cataract reports that their vision is BETTER in bright light conditions. How can this phenomenon be explained?

<p>Bright light constricts the pupil, reducing light scattering from peripheral opacities. (A)</p> Signup and view all the answers

In differentiating between various types of cataracts using slit-lamp examination, what specific characteristic is MOST helpful in identifying a nuclear cataract?

<p>Observation of amber, brown, black, or reddish colouration of the lens (C)</p> Signup and view all the answers

What is the significance of 'accurate projection of rays' in the context of advanced cataract diagnosis?

<p>It refers to the patient's capacity to perceive the direction of a light source, even with severely impaired vision. (C)</p> Signup and view all the answers

A patient with a long-standing history of nuclear sclerosis is examined. Which refractive error is MOST likely to be observed during retinoscopy?

<p>Myopia, due to increased refractive index of the lens. (D)</p> Signup and view all the answers

During a routine eye exam, the ophthalmologist notices that the patient's lens has a milky-white appearance. Based on this observation, which type of cataract is MOST likely present?

<p>Morganian hypermature senile cataract. (D)</p> Signup and view all the answers

What is the MOST comprehensive method for assessing the morphology (size, shape, pattern, and colour) of a cataractous lens?

<p>Slit-lamp examination with a fully dilated pupil. (D)</p> Signup and view all the answers

Flashcards

Senile Cataract

Clouding of the lens, often age-related.

Nuclear Cataract

Most common type of senile cataract (25%).

Posterior Subcapsular Cataract (PSC)

Senile cataract type (5%) located beneath the lens capsule.

Pre-senile Cataract

Senile cataract occurring before age 45.

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Age (as a Cataract Risk)

Most significant risk factor.

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Sex (as a Cataract Risk)

Females may be more prone.

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UV light and Cataracts

Early onset and maturation of senile cataract.

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Smoking and Nuclear Cataracts

Smoking increases the frequency of this type of cataract.

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ISC (Incomplete Senile Cataract)

Grey to white lens, vision 6/9 to CF+, iris shadow seen. Early stage of cataract.

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MSC (Mature Senile Cataract)

Milky white lens, HMI- to PL+, no iris shadow, complete cataract.

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HMSC (S) (Hypermature senile cataract Sclerotic)

Milky white with shiny spots, PL+, no red glow, shrunken lens

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HMSC (M) (Hypermature senile cataract Morgagnian)

Milky white cortex with sunken brownish nucleus, PL+ PR-.

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Index Myopia (Nuclear Cataract)

Increased myopia due to change in lens index of refraction.

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Grading of Nucleus Hardness

Slit-lamp grading scale for assessing lens nucleus density.

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Grade I Nucleus

Grade of nucleus hardness is soft with whitish color

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Phacoanaphylactic Uveitis

Inflammation due to leaked lens proteins acting as antigens.

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Phacomorphic Glaucoma

Glaucoma caused by a swollen, cataractous lens blocking the angle.

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Phacolytic Glaucoma

Glaucoma from macrophages engulfing leaked lens proteins, clogging meshwork.

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Incipient Cataract

Early stage of cortical senile cataract with vacuoles and water clefts in cortex.

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Cataract-Related Glare

Intolerance to bright light, common in early cataract stages.

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Immature Senile Cataract

Later stage where opacification progresses, but is not yet complete.

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Unocular Diplopia/Polypia

Doubling or tripling of objects, due to irregular refraction.

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Mature Senile Cataract

Opacification is complete, covering the entire cortex. Lens appears greyish-white.

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Hypermature Senile Cataract

The mature cataract left in situ, leading to further changes.

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Color Halos Around Lights

Perception of colored rings around lights due to light spectrum alteration.

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Nuclear Sclerotic Cataract Maturation

Progressive hardening of the lens nucleus, reducing accommodation ability.

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Color Spectrum Changes

Shift of color perception to yellow/brown, especially blue end of the spectrum.

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Morgagnian Hypermature Cataract

Hypermature cataract where the lens settles at the bottom of the capsular bag that is filled with milky fluid.

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Black Spots in Vision

Stationary dark spots in vision.

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Image Blur/Misty Vision

Vision is hazy or unclear.

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Cortical Cataract: Hydration of Lens Fibres

Changes include decreased function of active transport pump mechanism of ions.

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Posterior subcapsular senile

Central posterior cortex or just in the horizon.

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'Second Sight' in Cataracts

Improved near vision in nuclear sclerosis due to increased myopia.

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Mature Cataract

Complete opacity of lens with only light perception remaining.

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Iris Shadow Test

Using a light beam to detect lens opacity.

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Nuclear Cataract Lens Color

Amber, brown, black, or reddish lens color.

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