Cataract

Lens opacity (may be grossly visible)

Usually occurs bilaterally

Age-related cataract is the most common type

Most persons older than 60 have some degree of lens opacity

Multivitamin/mineral supplements and high dietary antioxidants may prevent the development of age-related cataract

Other causes

• Congenital infections or inborn errors of metabolism

• Secondary to systemic disease (diabetes mellitus, myotonic dystrophy, atopic dermatitis)

• Drugs (eg, topical, systemic, or inhaled corticosteroids [long-term])

• Uveitis

• Radiation exposure

• Ocular trauma

Gradually progressive blurred vision

No pain or redness

Even in its early stages, a cataract can be seen through a dilated pupil with an ophthalmoscope or slit lamp

As the cataract progresses, retinal visualization becomes increasingly difficult

When visual impairment significantly affects daily activities, surgical therapy is usually warranted

Treatment involves surgical removal and insertion of an intraocular lens of appropriate refractive power

Floppy iris syndrome

• Risk is increased in patients taking alpha-₁-adrenergic receptor antagonists (eg, tamsulosin [highest risk], alfuzosin, doxazosin, silodosin, or terazosin)

• There is no consensus on whether to stop alpha-blockers before surgery because the effects of the drug on the iris can persist for months to years

• The surgeon must know if the patient is taking an alpha-blocker to prepare for iris issues during surgery

• If the patient has not yet started an alpha-blocker and is planning to have cataract surgery shortly, it is best to wait until after surgery to begin the medication, if possible