This document discusses cataract, including its classification, etiology, stages of maturation, clinical features, and complications. It classifies cataracts based on etiology and morphology. The main types are congenital/developmental, senile, and traumatic cataracts. Senile cataracts can be cortical or nuclear. The stages of maturation for cortical cataracts include lamellar separation, incipient, immature, mature, and hypermature. Nuclear cataracts change color from white/green to amber, brown, or black. Clinical features include glare, polyopia, halos, blurred vision. Complications include uveitis, glaucoma from protein leakage, and lens subluxation

1. CONCEPT, MAGNITUDE & MANAGEMENT OF COMMUNICAL &
NON COMMUNICAL COMMON OCULAR CONDITIONs
/DISORDERs SUCH AS TRACHOMA, CATARACT, DIABETIC
RETINOPATHY, VARIOUS CORNEAL INFECTIONs & CONJUNCTIVAL
INFECTIONs
Dr. Vinit Kumar

2. Cataract
Dr. Vinit

3. Classification
• A. Etiological classification
• I. Congenital and developmental cataract
• II. Acquired cataract
• 1. Senile cataract
• 2. Traumatic cataract
• 3. Complicated cataract
• 4. Metabolic cataract
• 5. Electric cataract
• 6. Radiational cataract

4. • 7. Toxic cataract e.g.,
• i Corticosteroid-induced cataract
• ii. Miotics-induced cataract
• iii. Copper (in chalcosis) and iron (in siderosis)
• induced cataract.
• 8. Cataract associated with skin diseases
• (Dermatogenic cataract).
• 9. Cataract associated with osseous diseases.
• 10. Cataract with miscellaneous syndromes e.g.,
• i. Dystrophica myotonica
• ii. Down's syndrome.
• iii. Lowe's syndrome
• iv. Treacher - Collin's syndrome

5. • B. Morphological classification
• 1. Capsular cataract. It involves the capsule and
• may be:
• i. Anterior capsular cataract
• ii. Posterior capsular cataract
• 2. Subcapsular cataract. It involves the
• superficial part of the cortex (just below the
• capsule) and includes:
• i. Anterior subcapsular cataract
• ii. Posterior subcapsular cataract
• 3. Cortical cataract. It involves the major part
• of the cortex.
• 4. Supranuclear cataract. It involves only the
• deeper parts of cortex (just outside the nucleus).
• 5. Nuclear cataract. It involves the nucleus of the
• crystalline lens.

6. • 6. Polar cataract. It involves the capsule and
• superficial part of the cortex in the polar region
• only and may be:
• i. Anterior polar cataract
• ii. Posterior polar cataract

7. • Etiology
• A. Factors affecting age of onset, type and
maturation of senile cataract.
1. Heredity. incidence, age of onset and maturation
of senile cataract
2. Ultraviolet irradiations- exposure to UV
irradiation from sunlight
3. Dietary factors- proteins, amino acids, vitamins
4. Dehydrational crisis.
5. Smoking

8. • B. Causes of presenile cataract. The term
presenile
• before 50 years of age
1. Heredity
2. Diabetes mellitus. Nuclear cataract progress
rapidly.
3. Myotonic dystrophy
4. Atopic dermatitis

9. • C. Mechanism of loss of transparency - different in
nuclear and cortical senile cataracts.
• 1. Cortical senile cataract.

10. • Nuclear senile cataract.
• the total protein content and distribution of
cations remain normal.

11. • Stages of maturation
• [A] Maturation of the cortical type of senile
• cataract
• 1. Stage of lamellar separation.
• demarcation of cortical fibres owing to their
separation by fluid.
• demonstrated by slit-lamp
• reversible.

12. • 2. Stage of incipient cataract. In this stage early
• detectable opacities with clear areas between
them are seen.
• (a) Cuneiform senile cortical cataract
• (b) Cupuliform senile cortical cataract
• 3. Immature senile cataract (ISC).
• Greyish white
• iris shadow is visible.

13. • 4. Mature senile cataract (MSC)
• 5. Hypermature senile cataract (HMSC).
• (a) Morgagnian hypermature cataract
• (b) Sclerotic type hypermature cataract

14. • [B] Maturation of nuclear senile cataract
• diffusely cloudy (greyish) or tinted (yellow to
black) due to deposition of pigments.
• amber, brown (cataracta brunescens) or black
(cataracta nigra)
• reddish (cataracta rubra) in colour

15. • Clinical features
• Symptoms.
• 1. Glare- intolerance of bright light; such as direct
sunlight or the headlights ofan oncoming motor
vehicle.
• 2. Uniocular polyopia (i.e., doubling or trebling of
• objects)
• 3. Coloured haloes
• 4. Black spots in front of eyes
5. Image blur, distortion of images and misty vision
6. Loss of vision
• second sight- improved near vision
• Nuclear sclerosis

16. • Signs.
1. Visual acuity testing.
2. Oblique illumination examination.
3. Test for iris shadow.
4.Distant direct ophthalmoscopic examination
5.Slit-lamp examination

45. • Grading of nucleus hardness on slit-lamp
biomicroscopy.
• Grade of Description of Colour of hardness of
nucleus
• Grade I Soft White or greenish yellow
• Grade II Soft-medium Yellowish
• Grade III Medium-hard Amber
• Grade IV Hard Brownish
• Grade V Ultrahard Blackish (rock-hard)

46. Immature senile cataract versus
nuclear sclerosis
• 1. Painless progressive loss of
vision
• 2. Greyish colour of lens
• 3. Iris shadow is present
• 4. Black spots against red
fundal glow observed on
distant direct
ophthalmoscopy
• 5. Slit-lamp examination
reveals area of cataractous
cortex
• 6. Visual acuity does not
improves on pin-hole testing
testing
• 1. Painless progressive loss of
vision
• 2. Greyish colour of lens
• 3. Iris shadow is absent
• 4. No black spots / glow are
observed on seen against red
glow in DDO
• 5. Slit-lamp examination
reveals clear lens
• 6.Visual acuity usually
improve on pin-hole

47. • Complications
• 1. Phacoanaphylactic uveitis.
• A hypermature cataract may leak lens proteins into anterior
chamber. These proteins may act as antigens and induce
antigenantibody reaction leading to uveitis.
• 2. Lens-induced glaucoma.
• It may occur by different mechanisms e.g., due to intumescent
lens (phacomorphic glaucoma) and leakage of proteins into the
anterior chamber from a hypermature cataract (phacolytic
glaucoma).
• 3. Subluxation or dislocation of lens