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Samenvatting Diagnose & Plan
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Uitgebreide samenvatting van het vak Diagnose & Plan van jaar 3 optometrie aan de HU. Geschreven in het Engels en Nederlands.
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2017-18 DIAGNOSE & PLANOptometrie Jaar 3
Elise de Ruiter
HOGESCHOOL UTRECHT
,INTRO DIAGNOSE & PLAN ................................................................................................. 5
GRADING SYSTEMS........................................................................................................... 7
ANGLE GRADING SYSTEMS ....................................................................................................... 7
OOGLEDEN ....................................................................................................................... 9
ANATOMIE .............................................................................................................................. 9
OOGLEDEN ..................................................................................................................................... 9
CILIA................................................................................................................................................ 9
ANATOMIE HUID .......................................................................................................................... 10
NODULES & CYSTS ................................................................................................................. 11
MALIGNANT LESIONS ............................................................................................................. 12
BENIGN LESIONS .................................................................................................................... 16
ALLERGIC SKIN DISORDERS ..................................................................................................... 21
VIRAL INFECTIONS ................................................................................................................. 22
BACTERIAL INFECTIONS .......................................................................................................... 24
EYELID MARGIN DISORDERS ................................................................................................... 25
EYELASH DISORDERS .............................................................................................................. 29
ACHTERSTE OOGSEGMENT ............................................................................................. 31
ANATOMIE ............................................................................................................................ 31
CASUS 1 ................................................................................................................................. 33
CHOROIDAL NEOVASCULAR MEMBRANE (CNVM) ................................................................... 35
VITREOMACULAIR TRACTIESYNDROOM.................................................................................. 36
CASUS 2 ................................................................................................................................. 38
DOMINANTE FAMILIALE DRUSEN ........................................................................................... 39
AGE RELATED MACULAR DEGENERATION (AMD) .................................................................... 40
ZIEKTE VAN BEST.................................................................................................................... 41
ZIEKTE VAN STARGARDT ........................................................................................................ 42
CASUS 3 ................................................................................................................................. 43
HALFZIJDIGE EN BRANCH RETINALE VENENTAK OCCLUSIE (HRVO/BRVO)................................. 44
OPTOCILIARY SHUNT VESSELS ................................................................................................ 45
HOLLENHORST PLAQUE .......................................................................................................... 45
OCULAIR ISCHEMISCH SYNDROOM ......................................................................................... 46
BESTRALINGSRETINOPATHIE .................................................................................................. 47
VALSALVA RETINOPATHIE ...................................................................................................... 48
DIFFERENTIAAL DIAGNOSE ..................................................................................................... 48
GLAUCOOM ................................................................................................................... 49
ANATOMIE KAMERHOEK ........................................................................................................ 49
ANATOMIE OPTISCHE ZENUW ................................................................................................ 50
NIEUWE ONTWIKKELINGEN GLAUCOOM ................................................................................ 51
CASUS 1 ................................................................................................................................. 52
PAPIL VERANDERINGEN BIJ GLAUCOOM ................................................................................. 54
PRIMARY OPEN ANGLE GLAUCOMA (POAG) ........................................................................... 57
GLAUCOOM BEHANDELING .................................................................................................... 58
CASUS 2 ................................................................................................................................. 60
GONIOSCOPIE ........................................................................................................................ 62
ACUUT GESLOTEN KAMERHOEK GLAUCOOM .......................................................................... 64
SECUNDARY GLAUCOMA........................................................................................................ 66
,SYSTEMISCHE AANDOENINGEN ...................................................................................... 71
CASUS 1 ................................................................................................................................. 71
ROSS SYNDROOM .................................................................................................................. 73
HORNER’S SYNDROOM .......................................................................................................... 74
HOLMES-ADIE PUPIL .............................................................................................................. 75
ARGYLLE-ROBERTSON PUPILLEN ............................................................................................. 75
EMBOLI EN PLAQUES ............................................................................................................. 76
CASUS 2 ................................................................................................................................. 78
TOXOPLASMOSE .................................................................................................................... 79
ACUTE RETINALE NECROSE ..................................................................................................... 81
.............................................................................................................................................. 81
CASUS 3 ................................................................................................................................. 82
ZIEKTE VAN GRAVES............................................................................................................... 83
.............................................................................................................................................. 84
ORBITALE PSEUDOTUMOR ..................................................................................................... 84
ORBITALE TUMOR .................................................................................................................. 85
ASTHENOPIE DEEL II ....................................................................................................... 86
CASUS 1 ................................................................................................................................. 86
ANISOMETROPIE EN ANISEIKONIE .......................................................................................... 89
CASUS 2 ................................................................................................................................. 91
ESOFORIE TYPE DI .................................................................................................................. 93
CASUS 3 ................................................................................................................................. 93
IRREGULAIRE CORNEA .................................................................................................... 96
CASUS 1 ................................................................................................................................. 96
KERATOCONUS ...................................................................................................................... 98
PELLUCID MARGINAL DEGENERATION .................................................................................. 100
KERATOGLOBUS................................................................................................................... 100
POSTREFRACTIVE SURGERY ECTASIA .................................................................................... 101
POSTERIOR KERATOCONUS .................................................................................................. 101
CORNEAL ECTASIAS .............................................................................................................. 102
NEURO OPHTHALMOLOGY ........................................................................................... 103
OPTIC SHEATH MENINGIOMA (ONSM).................................................................................. 103
OCULAR ISCHEMIC SYNDROME ............................................................................................ 104
CASUS 1 ............................................................................................................................... 106
NEURITIS OPTICUS ............................................................................................................... 108
STROKE/EMBOLUS IN DE HERSENEN..................................................................................... 109
............................................................................................................................................ 109
ANEURYSMA / CAROTICO-CAEVERNEUSE FISTEL ................................................................... 110
TUMOR................................................................................................................................ 110
CASUS 2 ............................................................................................................................... 111
OEDEEM VAN DE PAPIL ........................................................................................................ 113
CASUS 3 ............................................................................................................................... 117
HYPOFYSEADENOOM ........................................................................................................... 119
TILTED DISC & GEZICHTSVELD ............................................................................................... 120
HET RODE OOG............................................................................................................. 121
CASUS 1 ............................................................................................................................... 121
BACTERIEEL KERATITIS ......................................................................................................... 122
STERIELE (NON-INFECTIEUZE) KERATITIS ............................................................................... 123
SCHIMMEL KERATITIS........................................................................................................... 124
,ACANTHAMOEBE ................................................................................................................. 125
HERPES SIMPLEX .................................................................................................................. 126
INTERSTITIELE KERATITIS ...................................................................................................... 128
CASUS 2 ............................................................................................................................... 129
UVEITIS ................................................................................................................................ 131
EPISCLERITIS ........................................................................................................................ 132
SCLERITIS ............................................................................................................................. 133
CASUS 3 ............................................................................................................................... 134
CONJUNCTIVITIS .................................................................................................................. 135
VIRALE CONJUNCTIVITIS ....................................................................................................... 135
BACTERIELE CONJUNCTIVITIS ............................................................................................... 136
............................................................................................................................................ 137
ALLERGISCHE CONJUNCTIVITIS ............................................................................................. 137
VERNALE CONJUNCTIVITIS ................................................................................................... 138
,INTRO DIAGNOSE & PLAN
Eerste 14 lessen VERPLICHT!
Resources
• Mediatheek – Up-To-Date
• Massechusettes Eye and Ear Infirmary
Voorbereiding
• Lees de studiehandleiding voor elke les door en bereid je goed voor.
• Aanleveren van de 5 MC-vragen in de sharepoint site! (ook van deze les)
• Voor het leveren van de vragen, houd de volgorde van de studiehandleiding aan!
Soms zijn de lessen niet altijd in dezelfde volgorde.
Lesopbouw
• Bespreking van minimaal 2 casussen
o Interactief volgens stappenplan uit de studiehandleiding
o Lees alle verplichte literatuur goed door zodat je aan de discussie kunt
deelnemen
• Discussie en bespreken van DDx
o In aansluiting op casuspresentatie
Spelregels
• Op tijd aanwezig! Anders wachten tot na de pauze
• Alleen pen en papier
Toetsing
• D&P1:
o MC-testvision toets 85 vragen
o 100 minuten
• D&P2:
o Aanwezigheidsplicht eerst 14 lessen
▪ Tekenen van presentielijst – zelf verantwoordelijk om dit te doen!!!
▪ Je mag van de 14 lessen 2 missen, niet meer! Als je 3 lessen mist, krijg
je per les die je hebt gemist een individuele casus ter uitwerking die je
zelf moet uitwerken.
o Aanleveren van 5 MC-vragen voorafgaand aan de bijeenkomst
▪ Controleer steeds of je de vragen wel goed hebt geüpload!
o Uitwerking casus (groepsopdracht) = toets
▪ Casussen en indeling werkgroepen docenten in week B3
▪ Uitwerking casus volgens stappenplan en SOEP-methode
▪ Beoordeling op
• Inhoud
• Verhaal
• Vormgeving
, • Taal- en spelfouten
• Literatuur (zie eisen in studiehandleiding)
o Min 4 litertuurverwijzing, waarvan 1 wetenschappelijke
artikel niet ouder dan 5 jaar
o Zoekstrategie bijvoegen
• Overzicht met individuele bijdrage groepsleden toevoegen
o Moet duidelijk en gelijk verdeeld zijn
Toetsvoorbereiding BOKS
• Body of Knowledge and Skills
o Staat alles in wat je voor de toets moet weten, maar ook voor de
oogheelkundige stage.
• Download alle documenten van de kliniek site, want daarna wordt het er allemaal
afgehaald.
Toetsvoorbereiding
• BOKS – continutoets (kliniek)
o Mag je dus vaker herhalen
• Optometric Championship
• Jeopardy
,GRADING SYSTEMS
ANGLE GRADING SYSTEMS
VON HERRICK
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)
SPAETH CLASSIFICATIE (OUD)
Kamerhoek (Spaeth)
E 50º Ciliary Body >1mm Extremely Deep
D 40º Ciliary Body Deep
C 30º Scleral Spur
B 20º Trabecular Meshwork (TM) Shallow
A 10º Trabecular Meshwork not visible! Extremely Shallow
Iris Verloop Pigmentatie TM (PI) Iris Processus (IP)
R = Regular
S = Steep
Q = Queer
,SPAETH CLASSIFICATIE (NEW)
E 50º Ciliary Body >1mm Extremely Deep
D 40º Ciliary Body Deep
C 30º Scleral Spur
B 20º Trabecular Meshwork Shallow
(minimal anterieure trabekelsysteem – niet filterend
deel – zichtbaar)
A 10º Trabecular Meshwork not visible! Extremely Shallow
Indien indentatie gonioscopie nodig is:
1. Noteer eerst de gradatie zonder indentatie
2. Verplaats de iris posterieur (indentatie)
3. Indien de gradatie nu anders is: noteer de gradatie ZONDER indentatie tussen
haakjes! De gradatie na indentatie is de echte irisaanhechting.
Iris Verloop!!! Pigmentatie TM (PI) Iris Processus (IP)
b = bowing anteriorly
p = plateau iris configuration
f = flat
c = concave posterior bowing
General Guidelines
• Occludable angles would include:
o Any angle narrower than 10 degrees
o Any p angle configuration
• Potentially occludable angles include
o Any angle narrower than 20 degrees
o Any B insertion
• Iris bow > 1+ usually indicates pupillary block
• Pigmentation >2+ is usually pathologic
,OOGLEDEN
ANATOMIE
OOGLEDEN
De huid van de oogleden is heel dun en sponsachtig en kan dus enorm zwellen (bijvoorbeeld bij het
huilen)
Lid Margin (2mm breed & 30mm lang)
• Vierkant
• Lacrimale puncta 5 mm mediaal
• Cilia - wimpers
• Grijze lijn
o In het midden van de ooglidrand bevindt
zich de ‘grijze lijn’, net voor de openening
van de klieren van Meibom. Deze is
meestal goed zichtbaar.
o Het is de overgang van de ooglidrand
naar het conjunctivale slijmvlies.
Aperatuur is meestal 8-12 mm breed.
Orbitaal Septum
• Mutligelaagd ‘plaat’ van fibreus weefsel
• Smelt samen met aponeurosis om ‘lid crease’ te vormen.
• Grens ooglid en orbita
CILIA
Cilia (Wimpers)
• Eerste defensie lijn
• 2 tot 3 rijen
• 100-150 bovenste ooglid
• 50-75 onder ooglid
• Zenuw plexus in elke follicle
• Klieren in elke follicle
• Vernieuwt elke 3 tot 5 maanden
• Hergroei 10 weken
, ANATOMIE HUID
Het huid van de oogleden is heel dun en sponsachtig, waardoor het erg kan zwellen (bijv bij
het huilen). Het bestaat uit epidermis, dermis and subcutaan weefsel.
EPIDERMIS
The epidermis is comprised of four layers of keratin-producing cells (keratinocytes). It also
contains melanocytes, Langerhans cells and Merkel cells. Cells migrate superficially,
undergoing maturation and differentiation through succesive layers.
SUBCUTAAN
De dermis ligt onder epidermis en bevat een netwerk van bloedvaten, lymfevaten en
zenuwvezels. De dermis biedt mechanische sterkte, buigzaamheid en bescherming voor de
ondergelegen weefsels.
Meibomian glands are modified sebacious glands found in the tarsal plates.
• Consists of a central duct with multiple acini, the cells of which synthesize lipids
(meibum) that form the outer lipid layer of the tear film.
Glands of Zeiss
• Modified sebaceous glands that secrete sebum
into the hair follicle, coating the eyelash shaft to
keep it from becoming brittle.
Glands of Moll
• Modified apocriene sweat glands
o Secretion composed of parts of cellular
cytoplasm
• Near the eyelash follicle
• Duct empties into Zeiss gland or onto lid margin
between the lashes
• Role in immune defense
Eccrine Sweat Glands
• Distributed throughout the eyelid skin
Pilocebaceous Units
• Comprise hair follicles together with their
sebaceous glands.
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