De'Chasta Eye Clinic

04/07/2025

😅🤓🤔

11/06/2025

🌟 Protect Your Sight – Prevent Vitamin A Deficiency! 👁️🥕

Did you know that Vitamin A Deficiency is one of the leading causes of preventable blindness in children?

Symptoms like dry eyes, poor night vision, and Bitot’s spots are early warnings ⚠️ — but with the right care, it’s 100% preventable!

11/06/2025

🔬 Traction in Proliferative Diabetic Retinopathy

🧬 Molecular mechanisms & PVR classification

📸 Source: Retina Image Bank
👁 Author: Malvika Singh
🏥 Co-author: Dr. Manish Nagpal, Retina Foundation, Ahmedabad, India

Case insights:
Fundus photograph of a 44 year old with uncontrolled diabetes showing fibrovascular proliferation and traction with details of disc and macula obscured with sclerosed vessels in the periphery.

In proliferative diabetic retinopathy (PDR), chronic retinal ischemia induces upregulation of VEGF, PDGF, and TGF-β, driving neovascularization and fibrocellular membrane formation. Myofibroblasts—transdifferentiated glial and RPE cells—contract these membranes via actin-myosin interaction, generating vitreoretinal traction and risking retinal detachment.

📚 PVR (Proliferative Vitreoretinopathy) is classified by location and severity:

• Grade A: Vitreous haze, pigment cells
• Grade B: Surface wrinkling, rolled edges
• Grade C: Full-thickness retinal folds
– C1–C3: focal to extensive
– Anterior vs. Posterior location
– Subretinal, Epiretinal, Intraretinal traction

Early detection of fibrovascular proliferation is key to preventing tractional retinal detachment.

29/05/2025

EXUDATIVE RETINOPATHY OF COATS (Retinal Telangiectasia)
Coats disease is a rare, idiopathic retinal vascular disorder characterized by abnormal development of retinal blood vessels (telangiectasia), leading to leakage of lipids and proteins into the retina and subretinal space. This condition most commonly affects young males and is usually unilateral.

ETIOLOGY AND PATHOPHYSIOLOGY:
1.Idiopathic condition (exact cause unknown).
2.Characterized by retinal telangiectasia—dilated, tortuous vessels.
3.Leads to exudation, hemorrhage, and exudative retinal detachment.
4.Blood-retinal barrier breakdown causes lipid-rich subretinal fluid accumulation.

CLINICAL FEATURES:
1.Typically presents in childhood (age 6–8 years) but can appear later.
2.Unilateral in >90% of cases.
3.Progressive vision loss.

SIGNS :
1.Retinal telangiectasia
2.Subretinal and intraretinal exudation (often yellow or white)
3.Exudative retinal detachment
4.Possible vitreous hemorrhage
5.Leukocoria (white pupillary reflex) in advanced cases

STAGES OF COATS DISEASE (Shields Classification):
1. Stage 1: Retinal telangiectasia only
2. Stage 2: Telangiectasia with exudation
3. Stage 3: Exudative retinal detachment (subtotal or total)
4. Stage 4: Total detachment with secondary glaucoma
5. Stage 5: Advanced end-stage disease (phthisis bulbi)

DIFFERENTIAL DIAGNOSIS:
1.Retinoblastoma (important due to similar presentation with leukocoria)
2.Retinal capillary hemangioma (von Hippel–Lindau)
3.Familial exudative vitreoretinopathy (FEVR)
4.Persistent fetal vasculature (PFV)

DIAGNOSIS:
1.Fundus examination: reveals abnormal vessels and exudation
2.Fluorescein angiography (FA): shows telangiectasia and leakage
3.OCT (Optical Coherence Tomography): reveals intraretinal or subretinal fluid
4.Ultrasound B-scan: used in cases with media opacity or total retinal detachment.

MANAGEMENT:
Depends on stage and severity:
1.Early stages (1–2):
★Laser photocoagulation of abnormal vessels
★Cryotherapy if laser is not feasible
2.Advanced stages (3–4):
★Scleral buckle or vitrectomy in selected cases
★Enucleation if painful blind eye (stage 5)
3.Anti-VEGF therapy (e.g., bevacizumab): sometimes used adjunctively

PROGNOSIS:
1.Better outcomes with early detection and treatment.
2.Advanced stages may lead to irreversible vision loss or globe loss.
3.Requires long-term follow-up due to recurrence risk.

27/05/2025

❇️ Horner Syndrome = Disruption of sympathetic innervation to the face and eye.

🔹 Classic Triad (Mnemonic: "PAM is H***y")
✔️ P – Ptosis (mild upper eyelid droop – ↓ superior tarsal muscle)
✔️ A – Anhidrosis (↓ sweating on affected side)
✔️ M – Miosis (constricted pupil – unopposed parasympathetic tone)

🔹 Anatomy: Sympathetic Pathway (3-Neuron Chain)
1st-order (Central): Hypothalamus → Spinal cord (C8–T2, ciliospinal center of Budge)

2nd-order (Preganglionic): Exit spinal cord → Travel over apex of lung → Synapse in superior cervical ganglion

3rd-order (Postganglionic): Travel along internal carotid artery → Eye & face

🔹 Causes by Lesion Location
🔸 Central (1st-order)
Brainstem stroke, spinal cord trauma, syringomyelia

🔸 Preganglionic (2nd-order)
Pancoast tumor, thyroid surgery, neck trauma

🔸 Postganglionic (3rd-order)
Carotid artery dissection, cavernous sinus pathology, cluster headache

🔹 Associated Findings
✔️ Anhidrosis affects entire face in central/preganglionic lesions
✔️ No anhidrosis in postganglionic lesions (sweat fibers travel with external carotid)
✔️ Ipsilateral facial flushing may be seen
✔️ Dilated pupil fails to dilate in darkness (sympathetic failure)

🔹 Diagnosis
✔️ Clinical (look for PAM triad)
✔️ Pharmacologic testing:

Co***ne test (fails to dilate pupil)

Apraclonidine test (denervation hypersensitivity → reverses miosis)
✔️ MRI or CT to localize lesion

Dr Austa

18/02/2025

01/12/2024

Happy new month

14/11/2024

Don't miss out

29/10/2024

When a WOMAN STOPS..

- CARING.
- Being JEALOUS.
- Asking QUESTIONS.
- BOTHERING about you.
- CALLING as usual.
- TEXTING you first.
- GOING through your phone.
- ASKING about female friends.
- Having SLEEPLESS NIGHTS.

And starts replying with.

- NAH.
- It's COOL.
- Oh OKAY.
- Ah FINE.
- I SEE.
- Am not MAD.
- OH K.

Then know that.

- Her
- Last
- Tears
- Has
- DROPPED
- For
You and
She no longer
CARES anymore.

MEN learn to value and TREAT your woman right. WOMEN have the HEART to LOVE but once you BREAK her, you won't find her in the same place you left her.

CLASS DISMISSED