Samenvatting KLOPTO 1.1

KLOPTO 1 GLAUCOOM
Optometrie Jaar 2 Blok A
Elise de Ruiter

,Table of Contents
VOORSTE OOGKAMER ....................................................................................................................... 3
GEZICHTSBANEN EN DE NERVUS OPTICUS ................................................................................ 9
GLAUCOOM I – Sander Beers ........................................................................................................ 18
GLAUCOOM II – Sander Beers ....................................................................................................... 29
GLAUCOOM DEEL 1 .......................................................................................................................... 39
GLAUCOOM DEEL 2 .......................................................................................................................... 46
NEURO OPHTHALMOLOGIE .......................................................................................................... 56
ORBITA ................................................................................................................................................. 65
TONOMETRIE ..................................................................................................................................... 77
GONIOSCOPIE ..................................................................................................................................... 80
WERKCOLLEGES ................................................................................................................................ 84
ONDERZOEKSPLAN...................................................................................................................................... 84
GONIOSCOPIE ................................................................................................................................................ 84
EVALUATIE EN PLAN ................................................................................................................................... 85

,VOORSTE OOGKAMER
STUDIEDOELEN
Kanski – Uveïtis ‘Clinical Features’
Artikel – Optometric Grading Scales ‘Limbal Anterior Chamber Depth’
Artikel – Optometric Management of Anterior Segment Eye Disease
Vocabulair: KP, C/F, Synechia, Hypopyon
 de diepte van de voorste oogkamer beoordelen met behulp van de van Herick methode.
de relatie van een nauwe en open kamerhoek met de van Herick methode uitleggen.
 de risico’s weergeven bij de gradering van de van Herick methode.
 de meting zelfstandig uitvoeren en noteren.
 de oorzaken die een nauwe kamerhoek veroorzaken of versterken omschrijven.
 het ziektebeeld uveïtis beoordelen en relateren aan klachten van de patiënt.
 de relatie tussen de oogdruk en uveïtis omschrijven.
 de relatie tussen systemische afwijkingen en uveïtis uitleggen.


ANATOMIE




(The lijn van schwalbe is het einde van Descemet’s membraan)


BEOORDELING DIEPTE VOORSTE OOGKAMER

Waarom?
 Bepalen of het toedienen van pupilverwijdende druppels
mogelijk is.
 Risico van kamerhoekafsluiting
o Acuut gesloten kamerhoekglaucoom.

Methodes
 Penlight – minste nauwkeurig
 Spleetlamp – Van Herrick
 Gonisocopie – zich op kamerhoekstructuur

,PENLIGHT TEST
Hold the penlight parallel to the plane of the iris and temporally in order to direct the light
nasally.
 Entire iris illuminated – anterior chamber is wide open (Grade 4)
 Shadow – shallowness of anterior chamber (Grade 1 to 3)




VON HERRICK
Doel: Diepte voorste oogkamer beoordelen

Methode
 Optic section op precies 60º
 Schijn het licht waar de cornea begint, net na de limbus
 Vergelijk Dac met Dc
o Anterior chamber depth (Dac)
o Cornea Depth (Dc)

,
,CONICAL BEAM

Doel: Helderheid voorste oogkamer (VOK) bepalen. Controleren op cellen of flare (wittige
waas).

Methode
 Kamer helemaal donker!
 Spleethoogte 2-3mm
o Kleinste of één na kleinste rondje
 Vergroting: Laag en Hoog
o Begin met 10x of 16x
o Vervolgens kijken met 25x en 40x
 Verlichting spleetlamp maximum
 40-50º graden

,ANTERIOR UVEITIS

Anterior uveïtis is inflammation involving the anterior uveal tract – the iris and anterior part
(pars plicata) of the ciliary body. The most common form of uveïtis.

 Acute anteior uveïtis (AAU) is the most common presentation.
o Usually Idiopathic and HLA-B27 related (50% of cases)
o Secondary to inflammation elsewhere in the eye

 Chronic anterior uveïtis (CAU) is less common.
o Bilateral, associated with systemic disease

o Associated with certain auto-immunity diseases
 Spondyloarthropathies (SpA) – disorders which primarily affect the
joints
 Ankylosing Spondylitis – involves lower spine problems
 Psoriasis
 Inflammatory bowel disease
 Reactive athritis

o Associated with inflammatory diseases
 Sarcoidosis – multisystem inflammatory disease
 Idiopathic Juvenile Athritis – affecting children
 Tubulointerstitial Nephritis – inflammatory kidney disorder

o Can be asymptomatic until the development of complications




Clinical Features (AAU)
 Symptoms.
o Unilateral pain, photophobia, redness and watery discharge, miosis, headache
(one-sided)
o Commonly recurrent (history of similar episodes)
 Visual Acuity.
o Only midly reduced.
o If severe, blurry vision
 Ciliary Injection
o Circumcorneal conjunctival hyperaemia
o Purplish hue (involvement deeper blood vessels)
 Anterior Chamber Cells
o Conical Beam
 Estimate number of inflammatory cells in a 1mm by 1mm slit beam field

,  Hypopyon
o Whitish purulent exudate composed of inflammatory cells in the inferior part of
the anterior chamber
o Common in HLA-B27-associated AAU
 Keratic Precipitates (KP)
o Greyish-brown deposits on the corneal endothelium composed of inflammatory
cells
o Usually concentrated inferiorly
 Aqueous Flare
o Haziness of the normally clear fluid in the anterior chamber (protein)
o Higher risk of complications
 Intraocular Pressure (IOP)
o May be reduced at first (impairment aqeous secretion by cilairy epithelium)
o May be elevated later (inflammatory cells, etc)
 Fibrinous Exudate
 Iris Nodules
 Posterior Syncechia (PS)
o Inflammatory adhesions between the pupil margin and the anterior lens capsule
o Pupil foten irregular and/or fixed
 Iris Atrophy
 Heterochromia Iridis
o Difference in colour between the iris of the two eyes
 Iris Neovascularization (Rubeosis Iridis)
o Particularly in chronic inflammation
 Cataract
o Mogelijke bijwerking door corticosteroïde gebruik

Investigation
 Anamnese.
o Ask about any auto-immune disease – especially joint or lower back pain and
any skin rashes.
 Spleetlamp
o Conical Beam
 Helderheid VOK bepalen
 Cellen en flare opsporen
o Oogdruk Meten
o Visus Meten

Treatment
 Mydriatics or Cycloplegics
o Atropine or Cyclopentolate
 1 or 2 drops
 2 or 3 times a day
o To reduce pain and prevent complications
 Prevents iris and ciliary muscle movement, reducing pain
 Topical Corticosteroids
o Prednisolone Acetate 1% (Predforte) or Dexamethosone 0,1% (Maxidex)
 Every 1-2 hrs, until inflammation is under control
 Tapered over the next 4-6 wks
 Check up weekly
o To control inflammation