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Opthalmology > Eye in Systemic Disease (neurological conditions) > Flashcards

Eye in Systemic Disease (neurological conditions) Flashcards

1
Q

what are the main features of neuro-ophthalmic disease

A

eye movement defects- double vision

visual defects- visual acuity, field loss

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2
Q

what is the biggest cause of eye problems

A

microvascular disease

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3
Q

what is de-myelination

A

loss of myelin shealth from (optic) nerve making it inefficient

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4
Q

what are inter-nuclear ophthalmoplegia (INO)

A

lesion affects medial longitudinal fasciculus (MLF) (inter nuclear connections) resulting in cranial nerve 3 and 6 being unable to coordinate their signals

=when the patient’s gaze is directed away from the side of the lesion, the ipsilateral (adducting) eye will not adduct and the contralateral (abducting) eye demonstrates horizontal nystagmus

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5
Q

what are supra nuclear defects

A

when problem with occular motility arises from an area before the cranial nerves

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6
Q

what muscles are affected by a 6th nerve palsy

A

lateral rectus (inability to abduct eye)

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7
Q

what type of diplopia will someone with a 6th nerve palsy get

A

horizontal

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8
Q

what can cause a 6th nerve palsy

A

microvascular
raised ICP
tumour
congenital

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9
Q

why is the 6th cranial nerve susceptible to raised ICP

A

as comes up from bottom of brain stem over the petrous tip

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10
Q

what causes papilloedema

A

raised ICP

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11
Q

what nerve is affected by a fourth nerve palsy

A

superior oblique (in ability to look medially (intorsion) and down (deoression in adduction), with palsy eye will lift when look medially)

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12
Q

what nerve palsy do you get a head tilt in

A

trochlear (IV) nerve palsy as trying to lift head to match high eye

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13
Q

what are the actions of superior oblique muscle

A

intorsion (adduction)
depression in adduction
weak abduction

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14
Q

what can cause a IVth nerve palsy

A

congential decompensated (will have double vision)
microvascular
tumour
bilateral (closed head trauma)

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15
Q

what is a compensated nerve palsy

A

where brain is still able to fuse two fields of vision so wont have diplopia

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16
Q

what is the longest cranial nerve. why is this important

A

trochlear- 4th

comes out of posterior brain stem- susceptible to trauma

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17
Q

what muscles does the occulomotor nerve supply (III)

A 
medial rectus
inferior rectus
superior rectus 
inferior oblique 
sphincter pupillae 
levator palpebrae superioris
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18
Q

what muscle palsy causes ptosis

A

levator palpaebrae superioris- CN III

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19
Q

what are the signs of a III nerve palsy

A

ocular position= down and out (lateral rectus and superior oblique only ones working)

droopy lid - ptosis

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20
Q

what can cause a III nerve palsy

A 
microvascular
tumour 
aneurysm (close to circle of willis)
MS
congenital
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21
Q

what can cause a PAINFUL third nerve palsy

A

aneurysm

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22
Q

what causes a PUPIL SPARING III nerve palsy

A

microvascular (as parasympathetics in III nerve on the outside- more likely to be affected by an aneurysm)

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23
Q

what are the key word causes of the three palsys

A

all caused by vasculopathic/ tumour

III= aneurysm 
IV= congenital/ trauma 
VI= cranial pressure
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24
Q

what can cause inter opthalmoplegia

A

MS, vascular, lots e.g. stroke

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25
what is the hallmark of MS on an MRI
plaque in ventricles cause by demyelination
26
what are the parts of the optic pathway
``` optic nerve chiasm optic tracts lateral geniculate nucleus (splits and goes to different levels of the lobes- right goes to left etc) optic radiations cortex (occipital lobe) ```
27
what can cause visual field defects
vascular disease space occupying lesion demyelination trauma (inc surgery)
28
why is there macular sparing in vision field loss caused by the visual cortex
as there is so many nerves within the macula
29
what are the pathologies of the optic nerve
ischaemic optic neuropathy optic neuritis (MS) tumours- meningioma, gliomas, haemangioma (vascular tumours)
30
will optic nerve defects present with horizontal or verticle defects
horizontal
31
will visual defects originating from the brain be horizontal or verticle
verticle
32
what are the features of optic neuritis
``` progressive visual loss (unilateral) pain behind eye (esp on movement) colour desaturation central scotoma (vision loss) gradual recovery over weeks- months ```
33
what is very specific to optic nerve damage
colour desaturation- will see differences in the colour red between eyes
34
what can follow optic neuritis
optic atrophy
35
what can affect the optic chiasm
pituitary tumour craniopharyngioma meningioma
36
what reflex is seen in a chiasm pathology
RAPD
37
what field defect will result from an optic chiasm pathology
bi-temporal
38
what happens to visual loss caused by pituitary tumours after the tumour is decompressed or removed
commonly reversed
39
how are pituitary tumours removed
via transsphenoidal surgery
40
what can affect the optic tract and radioatoins
tumours (primary and secondary) demyelination vascular anomalies
41
what visual defects arise from pathologies within the optic tracts and radiations
homonomous macula not spared quadrantanopia incongrous
42
where do you know a pathology is if it is a quadrantanopia
after the lateral geniculate nucleus
43
why dont you get raised ICP in meningiomas
as grows very slowly
44
what pathologies can affect the occipital cortex
``` vascular disease (infarct) demyelination ```
45
what visual field defects do you get from pathologies in the occipital cortex
homonomous macular sparing congruous
46
what visual field defects are macular sparing
ones originating from the occipital cortex
47
what will cause lots of whits dots in a specific pattern that are all the same size in the eye
laser retinopathy treatment
48
what is the commonest cause of blindness in the western world
ARMD
49
what is the pathogenesis of diabetic retinopathy
chronic hyperglycaemia = glycosylation of protein/ basement membrane = loss of pericytes (cells on outer layer of capillaries) = microaneurysm = leakage/ ischaemia
50
what are the signs of non proliferative retinopathy
micro aneurysms/ dot and blot haemorrhages (red small dots) hard exudates (yellow dots) cotton wool patches (fluffy white patches of oedematous axons on the retina) abnormal venous calibre (vessels not smooth) intra-retinal microvascular abnormalities
51
what does ischaemia in the eye lead to
production of VEGF which causes neovascularisation- fragile vessels prone to haemorrhage fibrotic scarring- shrink= retinal detachment
52
what is NVE and NVD
NVD= neovascularisation on optic nerve head NVE= neovascularisation in the periphery of the retina
53
when does neovascularisation show that ischaemia is severe
if there are new vessels growing on the iris also by the time you have NVD you have profound loss of useful vessels
54
how do you know where ischaemia is in eye
fine white vessels show closed arteries and venules- neovasularisation should stem from here
55
what is rubeosis iridis
when VEGF diffuses through vitreous into iris very severe ischaemia in the eye causes secondary glaucoma no sight restoration neovascularisation in the iris
56
why do diabetic patients go blind
retinal oedema affecting the fovea vitreous haemorrhage scarring/ tractional retinal detachment
57
what are types of retinopathy
``` non proliferative (mild, moderate and severe) proliferative retinopathy ```
58
how do you classifymaculopathy
observable (vision hast deteriorated) referable maculopathy clinically significant maculopathy (oedema has spread to the centre of the fovea (foveal dip)
59
what happens to the foveal dip when oedema hits it
will pop up (like an umbrella inside out) and vision blurs
60
how do you manage diabetic retinopathy
optimise medical management of diabetes laser- PPR (pan retinal photocoagulation), macular grid surgery- vitrectomy rehab- blind/ partially sighted
61
how does the laser work in diabetic retinopathy
kills bots of retina do reduce oxygen demand to rest of eye so centre can receive more nutrients and oxygen
62
are axons below or above the photoreceptors
above, light has to go through them to reach the photo receptors
63
why does the eye look pink
blood vessels in the choroid showing through
64
how do you treat disc neovascularisation
laser
65
how do you treat maculopathy
laser macula (less used now) or injections of VEGF antibodies
66
what shows the severity of hypertension in the eye
how the fundus looks and the retinal arteries
67
why do you people have hypertensive retinopathy
usually malignant hypertension
68
what does hypertensive retinopathy look like
``` like diabetic attenuated blood vessels (look like copper or silver wire) cotton wool spots hard exudates retinal haemorrhage optic disc oedema ```
69
what are the features of central retinal artery occulsion
cattle tracking in vessels retinal oedema (pale) foveal dip doesnt go white as axons over this so thin they dont go oedematous sudden painless loss of vision (v profound) retinal nerve fibre layer becomes swollen except the fovea (cherry red spot) rarely recovers
70
why dont you get necrosis in macula in CRAO
as choroid supply very good here
71
what are the features of central retinal vein occlusion
``` no neovascularisation haemorrhages sudden painless visual loss range of visual loss haemorrhagic and exudative process downstream from occluded vein ```
72
why does the CRV occlude in diaebtes
Anulus- limited size hole for central artery and vein. When retina becomes bigger in hypertension it occludes this hole
73
what is used to image the capillary bed in CRVO
angiogram
74
what are the features of branch vein occlusion
painless disturbance in vision may be assymptomatic may be aware of loss of part of field
75
what are the features of sarcoidosis
uveitis- keratic precipitate lung involvement non caseating granulomas
76
what are the infective causes of uveitis
``` TB herpes zoster (and simplex) toxoplasmosis candidiasis syphillis lyme disease ```
77
what are the non infective causes of uveitis
``` idiopathic HLA-B27 juvenile arthritis (not it RA) sarcoidosis behcets disease ```
78
what is the histology of GCA
loss of lumen size, destruction of the lamina, multinucleated giant cell accumulation
79
what are the features of GCA
``` inflammation of middle sized arteries associated with polymyalgia rheumatica headache jaw claudication malaise raised PV blinding condition ```
80
what condition is GCA associated with
polymyalgia rheumatica
81
what are the features of thyroid eye disease
extra ocular: - proptosis (due to muscle and fat swelling) - lids: retraction, chemosis (conjunctival oedema), lag, pigmentation - restrictive myopathy (diplopia) ocular: - anterior segment: chemosis, injection, exposure (cant close eye well), glaucoma - posterior segment: choroidal folds, optic nerve swelling
82
what is the most common cause of unilateral and bilateral proptosis
thyroid eye disease
83
how do you treat thryoid eye disease
medical control- carbimazole, radioiodine, surgery
84
what are the eye features of SLE
ocular inflammation
85
what are the occular features of RA
dry eyes (keratoconjunctivitis sicca) scleritis corneal melt (doesnt give yo intraocular inflammation- affects the surface of the eye)
86
what are the features of sjogrens syndrome
``` keratoconjunctivitis sicca xerostomia (dry mouth) dry featureless tongue RA infiltration of lacrimal glands ```
87
what are the features of marfans
Displacement of the lens (zonules) spontaneously rupture Long fingers high arched palate tall
88
what way does the lens always dislocate in marfans
upwards(m for moon)
89
what dermatological features can affect the eyes
``` steven- johnson syndrome/ erythema multiforme drug or food hypersensitivity maulopapular rash stomatitis conjunctivitis ```
90
what are the features of stevens-johnsons syndrome
symblepharon ( partial or complete adhesion of the palpebral conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball) occlusion of lacrimal glands corneal ulcers
91
what is the medial longitudinal fasiculus
in grey matter | links CN VIII to eye movement nerves (CN III, IV and VI)
92
what is the presentation of INO
inability to adduct (on side of lesion) and horizontal nystagmus on other eye
93
what cranial nerves are affected in internuclear ophthalmoplegia
CN III and VI (3 and 6) | remember its a horizontal nystagmus

Opthalmology (16 decks)

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