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11. The Eye > 11.7.4 Systemic Diseases > Flashcards

11.7.4 Systemic Diseases Flashcards

1
Q

Graves’ disease - endocrine (NB)
Pathogenesis
Visual system abnormalities

A

PATHOGENESIS
- Autoimmune disorder in which an antibody to the thyroid stimulating hormone receptor causes hyperthyroidism
- postulated that the same antibody binds to receptors in orbital tissues to produce the associated orbital abnormalities.
- Orbital complications can present before, concurrent with, or after the endocrine abnormalities.

VISUAL SYSTEM ABNORMALITIES
- Eyelid swelling.
- Eyelid retraction resulting in a staring expression.
- Lid lag.
- Conjunctival chemosis and erythema.
- Proptosis = exophthalmos
- Limitation of eye movements which may lead to diplopia.
- Exposure keratopathy.
- Optic neuropathy due to pressure from swollen eye muscles and other intraorbital soft tissues.

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2
Q

Diabetes mellitus - metabolic disease
General
Visual system abnormalities
Visual system abnormalities

A

GENERAL
- ocular complications only after the disease has been present for many years, but may also occur without the pt being aware of being diabetic.
- ocular manifestations that can lead to blindness if the disease is not recognised and treated in good time.
- should undergo a thorough eye examination at least once a year.

VISUAL SYSTEM ABNORMALITIES
GENERAL
- Increased incidence of superficial and deep infections: blepharitis, conjunctivitis, preseptal cellulitis, orbital cellulitis.
LENS
- Sudden refractive changes as a result of poor metabolic control.
- Cataract.
UVEA
- Increased incidence of anterior uveitis.
RETINA
- Diabetic retinopathy
GLAUCOMA
- Neovascular glaucoma: a fibrovascular membrane grows over the iris and angle structures.
NEUROOPHTHALMOLOGY
- Extraocular muscle paralysis usually presenting with diplopia.
- clears spontaneously within a few months.
- paralysis of III it is characteristic that the pupil is spared

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3
Q

Examples of cardiovascular system diseases

A

Hypertension & Arteriosclerosis
- Retinal vasculopathies

Vascular occlusions
- Retinal arterial and venous occlusions
- Ciliary arterial occlusions

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4
Q

Rheumatoid Arthritis - Collagen diseases

A
  • Dry eyes (keratoconjuctivitis sicca) ➡️ irritation and decreased surface immunity ➡️ an increased incidence of corneal infections by bacteria and fungi.
  • Peripheral corneal thinning that may lead to corneal perforation.
  • Scleritis:
    ➡️ very poor prognostic sign
    ➡️ usually indicative of a flare-up of the systemic disease.
    ➡️Patients with this complication have a greater tendency to die of the systemic complications.
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5
Q

Juvenile chronic arthritis (JCA) - Collagen diseases

A
  • Chronic anterior uveitis = most common ocular complication.
  • usually asymptomatic, but leads to the development of posterior synechiae, dense cataracts and glaucoma that are very difficult to treat if not detected early.
  • Eye complications more common in pt with monoarthritis than in those with severe systemic disease.
  • must be examined early and regularly (every three months for those with monoarthritis) by an ophthalmologist, even if they do not complain of eye problems
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6
Q

Ankylosing spondylitis - collagen diseases

A
  • affects mainly young men.
  • Recurrent attacks of acute painful anterior uveitis are the most common ocular complication
  • uveitis may present before the spondylitis
  • All patients with acute anterior uveitis of unknown cause must have X-rays of the sacroiliac joint and be referred to a physician.
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7
Q

SLE - Collagen diseases
Visual system abnormalities
CNS complications may lead to

A

VISUAL SYSTEM ABNORMALITIES
- Dry eyes.
- Peripheral corneal thinning.
- Anterior uveitis.
- Retinopathy is the most important eye complication of this disease and may present with retinal haemorrhage, cotton wool spots and optic disc swelling.

CNS COMPLICATIONS MAY LEAD TO THE FOLLOWING
- homonymous hemianopia.
- Optic atrophy
- III and VI paresis.

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8
Q

Reiter’s syndrome - collagen diseases

A
  • Classical triad of nonspecific (nongonococcal) urethritis, arthritis and conjunctivitis.
  • Uveitis and keratitis may also occur.
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9
Q

Behcet’s syndrome - collagen diseases

A

Classical triad of oral and genital ulceration, arthritis and anterior uveitis.
NB for test

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10
Q

Giant cell arteritis (Temporal arteritis) - collagen diseases

A
  • Arteritis of medium and large arteries usually presents in people older than 60 years with headache, weight loss and tender temporal arteries.
  • may suddenly lose their vision due to:
    (a) Anterior Ischaemic Optic Neuropathy (AION)
    (b) Central Retinal Arterial Occlusion (CRAO)
  • emergency, because, without treatment, the second eye can be affected within days.
  • They may present with cranial nerve fallout e.g. III, VI.
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11
Q

AIDS - NB
Visual system manifestations

A

AIDS virus retinal vascular involvement
- Cotton wool spots: areas of nerve fibre layer ischaemia, usually transient in nature with no prognostic value.
- Microaneurysms.
- Retinal haemorrhages.

Opportunistic infections
- Herpes zoster ophthalmicus may be the first manifestation of the disease.
- Cytomegalovirus retinitis is associated with a reduced life expectancy.
- Toxoplasma retinochoroiditis.
- Cryptococcus neoformans retinochoroiditis.

Neoplasms
- Kaposi’s sarcoma of the eyelids, conjunctiva and orbit.
- Squamous carcinoma of the eyelids and conjunctiva.
- Burkitt’s lymphoma of the orbit.

Neuroophthalmic signs of intracranial disease
- Cranial nerve paresis.
- Field defects.
- Disc swelling.
- Optic atrophy.
- Pupillary abnormalities.

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12
Q

Define phacomatoses

A

Group of diseases in which neurological abnormalities are associated with congenital defects of the skin, eye and other organs.

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13
Q

Sturge-weber syndrome - Phacomatoses
Visual system abnormalities
Other systemic abnormalities

A

VISUAL SYSTEM ABNORMALITIES
- Conjunctival haemangioma.
- Choroidal haemangioma.
- Open angle glaucoma probably due to a combination of a developmental angle anomaly and haemangioma induced raised venous pressure.

OTHER SYSTEMIC ABNORMALITIES
- Facial haemangioma: port wine stain.
- Meningeal haemangioma: seizures.

For test
- visual system abnormalities
- why high risk for open angle glaucoma

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14
Q

Neurofibromatosis - Phacomatoses
Visual system abnormalities
Other systemic abnormalities

A

VISUAL SYSTEM ABNORMALITIES
- Eyelid neuroma.
- Iris nodules (Lisch nodules)
- Open angle glaucoma.
- Choroidal naevus.
- Optic nerve glioma.

OTHER SYSTEMIC ABNORMALITIES
- Skin neurofibromas.
- CNS tumours.
- Endocrine tumours.

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15
Q

Main visual system problems produced by collagen diseases

A
  • dry eyes
  • peripheral corneal thinning
  • scleritis
  • anterior uveitis
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11. The Eye (13 decks)

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