Examination and Management

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1. Document visual acuity.

2. Afferent pupil defect (see p. 7) in severe cases only.

3. Fundus examination - whole retina affected in CRVO (Fig. 4.5) only part of retina affected in BRVO (Fig. 4.4).

4. Retinal hemorrhages - may be few or widespread often with cotton wool spots (patchy white retinal lesions secondary to ischemia) and blurred disc margins.

5. Raised intraocular pressure - over 21 mmHg - predisposes to vein occlusion - if you do not have experience measuring this, you are unlikely to obtain an accurate reading - leave to the ophthalmologist. If a tonopen (portable tonometer) is available - then use and document pressure.

6. Measure and treat blood pressure as required.

7. Check urine and random blood for diabetes.

Fig. 4.4 A superotemporal branch vein occlusion - the hemorrhages and edema affect the macula region and vision is reduced. If the blockage is more peripheral vision may be spared. Note the cotton wool spots indicating ischemia.
Fig. 4.5 Central retinal vein occlusion.

8. Send blood for FBC, plasma electrophoresis, blood sugar and cholesterol.

9. Advise patient to stop smoking.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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