Eye in systemic disease

Question 1

????

Answer 1

!!!!

Question 2

Describe the pathogenesis of diabetic retinopathy

Answer 2

chronic hyperglycaemia
glycosylation of protein/BM
loss of pericytes
microaneurysm causing leakage and ischeamia

Question 3

name 5 signs of non-proliferative retinopathy

Answer 3

microaneurysms/dot & blot haemorrhages
hard exudate
cotton wool patches
abnormalities of venous calibre
intra retinal microvascular abnormalities

Question 4

name the appearance of new vessels

-why does this occur?

Answer 4

neovascularisation

-as a result of ischeamia: VEGF released causing new vessels to grow, they are always thinner and weaker and so cause haemorrhage

Question 5

name the ways in which a diabetic patient can suffer from visual loss (3)

Answer 5

-retinal oedema affecting the fovea
vitrous haemorrhage
scarring/tractional retinal detachement

Question 6

name the categories in retinopathy classification (5)

Answer 6

none
mild
moderate
severe
proliferative retinopathy

Question 7

name the categories in maculopathy classification

-management

Answer 7

none
observable
referable
clinically significant

-laser treatment: makes tissue die so no longer reduces VEGF
surgery: vitrectomy
rehabilitation and management of blindness

Question 8

hypertension

describe the appearance on fundoscopy of hypertensive retinopathy (6)

Answer 8

cotton wool spots & retinal haemorrhage 
star arrangement of hard exudate
Disc swelling
Arteriovenous nipping
optic disc oedema

Question 9

Central retinal artery occlusion

• presentation
• sign

Answer 9

• sudden painless profound loss of vision

- cherry red spot (retinal nerve fibre layer swollen apart from at fovea)

Question 10

appearance on branch vein occlusion

Answer 10

one half of the eye normal and other half shows do/blot haemorrhage etc

Question 11

Giant cell arteritis

• what is it
• symptoms
• reason for visual loss

Answer 11

-inflammation of middle sized arteries, assoc polymyalgia rheumatica

-headache
jaw claudication
malaise
raised P.V
blinding- swollen disc and v swollen axons, exoplasmic flow arrested as it leaves the eye

Question 12

thyroid eye disease

• features: ocular (3) and extra-ocular (5)
• management (3)

Answer 12

• extra ocular: proptosis, lid retraction/lag, restrictive myopathy
  ocular: chemosis, injection, glaucoma, choroidal folds, optic nerve swelling

-lubricants
manage the thyroid dysfunction
surgical decompression

Question 13

name the connective tissue diseases that can cause ocular problems (4)

Answer 13

SLE
anti-DNA Ab, causes ocular inflammation

RA
dry eyes, can lead to scleritis and corneal melt

Sjogren’s sydnrome
triad: keratoconjunctivits sicca(dry eyes)
Xerastomia
RA

Marfans
anterior lense dislocation