Cataract

A 57 years old male patient named Mahesh ; teacher by occupation, residing at Asif nagar , came to
the OPD with chief complaints of:

Diminished vision since 6 months in both eyes ( RE > LE )

History of Presenting illness:

He was apparently asymptomatic 6 months back.

He then noticed diminished vision, gradual in onset, progressive in nature and painless Diminution of
vision is (same for near and distance / more for near / more for distance).

 Diminution of vision is more for Right eye than left eye ,

 Diminution of vision is more for distance vision ,
 Diminution of vision is more in day light
 Diminution of vision is associated with Glare and coloured halos ,
 Significant negative history of : redness, double vision , pain

Ocular History:

 He doesn’t wear specs.

 He has no history of ocular surgery / ocular trauma
 He has no history of eyedrops for a long duration

Past History:

 No History of : similar complaints in the past , DM , HTN , COPD , Asthma , IHD , Injuries
 No History of drug intake/ drug allergies

Family History: Not Significant

Personal History: He is calm , cooperative and well oriented with time, place and person

Examination:

General Examination: Patient is Conscious, Coherent, Cooperative; Comfortably sitting

 BP : 120/80 mmHg
 PR : 82 bpm
 RR : 20 breaths/min
 Temp : Normal
Ocular Examination:

 Head posture – Normal , erect and straight posture without any tilt of head or turn of face or
elevation/ depression of chin or any abnormal movements of the head.

 Facial symmetry and Ocular symmetry –

- Facial symmetry – maintained

- Forehead : symmetrically wrinkled
- Both sides of face are symmetrical in appearance,
- both eyebrows and eyelids at same level, With symmetrical nasolabial folds,
- angle of mouth of both sides symmetrical.

 Ocular posture – Normal visual axes are parallel to each other. (Orthophoric) (HRCT)

RT EYE LT EYE

 VISUAL ACUITY :
1. Distance vision :
i) Uncorrected/unaided: PL+ , PR + in all quadrants 6/36
+

+ +

ii) With pinhole : 6/18

iii) (Best corrected, if specs)

2. Near vision : N6 N6
3. Colour vision : Correctly read Correctly read

 EYE BROWS :
Symmetrically placed on each side of face, curved
with convexity upwards

 EYE LIDS :
- Position : Normal, upper covers Normal, upper covers
2mm of upper cornea , 2mm of upper cornea
lower touches the limbus , lower touches the
limbus
 RT EYE LT EYE
- Margin : Anterior – round border Anterior – round
Posterior – sharp border border
Posterior – sharp
border

- Movements : 12 blinks/min 12 blinks/min

- Skin over lids : Thin, smooth , elastic Thin, smooth , elastic

 PALPEBRAL APERTURE WIDTH : Vertical : 10mm Vertical : 10mm

Horizontal : 30mm Horizontal : 30mm

 EYE LASHES :
- Colour : Black colour ( normal ) Black colour
( normal )
- Direction: Upper – forwards upwards
backwards Upper – forwards
Lower – forwards upwards backwards
downwards backwards Lower – forwards
downwards
- Density : Single row of eye lashes backwards
( normal )
Single row of eye
lashes ( normal )
 LACRIMAL APPARATUS :
- Puncta : Patent Patent
- Skin over lacrimal sac area : Normal Normal
- REGURGITATION TEST : -ve ( normal ) -ve ( normal )

 EYE BALL :
- Position : Normal Normal
- Movements : UNIOCULAR : UNIOCULAR :

BINOCULAR : BINOCULAR :
 RT EYE LT EYE

 CONJUNCTIVA
- Palpebral Normal Normal
- Bulbar Normal Normal
- Fornix Normal Normal

 CORNEA
- Size Horizontal diameter= Horizontal
11.7mm diameter= 11.7mm
Vertical Diameter = 11mm Vertical Diameter =
11mm

- Shape Elliptical Elliptical

- Surface Smooth Smooth
- Sheen Maintained Maintained
- Transparency Maintained Maintained
- Sensations intact intact

 SCLERA : White colour (normal) White colour

(normal)

 ANTERIOR CHAMBER :
- Depth : Normal in depth Normal in depth
- Contents : Optically clear with no Optically clear with
abnormal contents no abnormal
contents

 IRIS :
- Colour : Dark brown (normal) Dark brown (normal)
- Pattern : Radial (normal) Radial (normal)

 PUPIL :
- Number : Single Single
- Site : Centronasal Centronasal
- Size : 3mm in size 3mm in size
- Shape : Round Round
- Colour : Pearly white grayish white
- Pupillary reactions :
 Direct light reflex Constricts (normal) Constricts (normal)
 Indirect light reflex Constricts (normal) Constricts (normal)
 Near reflex Constricts (normal) Constricts (normal)

 LENS :
- Position : Intact Intact
- Colour : Pearly white grayish white
- Transparency : lost lost
PROVISIONAL DIAGNOSIS :

Right sided mature cataract ( probably nuclear cataract ) and left sided immature cataract
with refractive error.

DIFFERENTIAL DIAGNOSIS :

- Primary open angle glaucoma

- Age related macular degeneration
- Chorioretinal degeneration