Eye in systemic disease - Neurology

Question 1

most common cause of blindness and partial sight in 16-64 yr olds?

Answer 1

diabetic retinopathy

Question 2

most common overall cause of blindness and partial sight?

Answer 2

ARMD

Question 3

describe the pathogenesis of diabetic retinopathy

Answer 3

chronic hyperglycaemia > glycosylation of protein/basement membrane > loss of pericytes > microaneurysm > leakage or ischaemia from abnormal vessels

Question 4

name 3 signs of background retinopathy

Answer 4

microaneurysms
blot haemorrhages
hard exudates

Question 5

in what 3 places can new blood vessels grow?

Answer 5

grow on disc (NVD)
grow in periphery (NVE)
grow on iris if ischaemia is severe

Question 6

what does the site of new vessel growth indicate?

Answer 6

where the damage is

i.e - new vessel growth at the disc indicates vascular damage at the central retinal artery etc

Question 7

what is rubeosis iridis?

Answer 7

vessel growth into the iris
no sight restoration
leads to glaucoma etc

Question 8

diabetic patients lose vision as a result of what 3 processes?

Answer 8

haemorrhages
scarring/tractional retinal detachment
retinal oedema affecting the fovea

Question 9

2 classifications of diabetic eye disease?

Answer 9

retinopathy

maculopathy

Question 10

classifications of retinopathy?

Answer 10

non-proliferative
- mild 
- moderate
- severe
proliferative

Question 11

what are the stages of maculopathy?

Answer 11

no maculopathy
observable maculopathy
referable maculopathy
clinically significant maculopathy

Question 12

what is maculopathy?

Answer 12

damage to the macula

Question 13

how do you know if maculopathy is significant?

Answer 13

if macula is raised

needs 3D imaging

Question 14

sign of previous laser eye surgery?

Answer 14

spots of yellowish colour all over eye

- laser changes composition of protein?

Question 15

disc neovascularisation?

Answer 15

growth of new vessels in optic disc

Question 16

how can proliferative disc neovascularisation be managed (diabetes)?

Answer 16

laser burns

Question 17

management of maculopathy (diabetes)?

Answer 17

laser photocoagulation

anti VEGF injections

Question 18

how can the eyes relate to hypertension?

Answer 18

appearance of fundus correlates to severity of hypertension and the state of the retinal arterioles
young people can have extensive retinopathy (as usually due to malignant hypertension if <35)
elderly patients with arteriosclerotic vessels often have minimal changes

Question 19

signs of hypertensive retinopathy?

Answer 19

cotton wool spots (also in diabetic but very characteristic of hypertensive)
poorly defined disc margains (optic disc oedema)
retinal haemorrhages
hard exudates
attenuated blood vessels - copper or silver wiring

Question 20

presentation of accelerated hypertension?

Answer 20

usually young patients
very dramatic fundal appearance
can have decreased vision

Question 21

cattle-trucking of vessels and white retina with sparing of fovea are signs of what?

Answer 21

central retinal artery occlusion

Question 22

features of central retinal artery occlusion?

Answer 22

sudden painless loss of vision
very profound loss of vision
retinal nerve fibre layer becomes swollen except at fovea (cherry red spot)
rarely recovers

Question 23

4 signs of central retinal vein occlusion?

Answer 23

sudden painless visual loss
range of visual loss
need to determine degree of ischaemia
ischaemia correlates to degree of reduced vision and fundal appearence

Question 24

what can cause central retinal vein occlusion?

Answer 24

annulus where axons and central retinal artery and vein leave the eye is a limited size
in hypertension, artery gets thicker which can impinge on vein causing central retinal vein occlusion

Question 25

what is the worry in central retinal vein occlusion?

Answer 25

rubeotic eye - growth of vessels in iris basically end game, nothing you can do for it

Question 26

features of branch vein occlusion?

Answer 26

only part of the retina is affected may have no symptoms unless the affected vein supplies the centre painless disturbance in vision may be aware of loss of part of visual field usually found by optician

Question 27

features of sarcoidosis

Answer 27

non-caseating granuloma eye problems bilateral hilar lymphadenopathy erythema nodosum

Question 28

name 6 infective causes of uveitis

Answer 28

``` TB herpes zoster toxoplasmosis candidiasis syphilis lyme disease ```

Question 29

name 5 non-infective causes of uveitis

Answer 29

``` HLA-B27 (most common) idiopathic syndrome juvenile arthritis (not RA) sarcoidosis Behcet's disease ```

Question 30

8 features of giant cell arteritis?

Answer 30

``` inflammation of middle sized arteries associated with polymyalgia rheumatica headache jaw claudication malaise raised PV (plasma viscosity) raised alk phos blinding condition ```

Question 31

how does giant cell arteritis affect the optic nerve head?

Answer 31

peripheral ciliary arteries are affected (not central retinal artery)

Question 32

proptosis/exopthalmus (bulging eyes) suggests what?

Answer 32

thyroid eye disease

Question 33

extraocular signs of thyroid eye disease?

Answer 33

``` proptosis lid signs - retraction - oedema - lag - pigmentation restrictive myopathy ```

Question 34

ocular signs of thyroid eye disease?

Answer 34

``` anterior segment - chemosis - injection - exposure of cornea - glaucoma posterior segment - choroidal folds - optic nerve swelling ```

Question 35

swelling of the extraocular muscles and orbital fat suggest what?

Answer 35

thyroid eye disease

Question 36

management of thyroid eye disease?

Answer 36

control of thyroid dysfunction lubricants surgical decompression

Question 37

features of aye affected by SLE?

Answer 37

deep inflammation | red sclera

Question 38

what 3 affects can RA have on the eye?

Answer 38

dry eyes (keratoconjunctivitis sicca) scleritis corneal melt

Question 39

triad of features in sjogrens syndrome?

Answer 39

keratoconjunctivitis sicca xerostomia RA also get infiltration of lacrimal glands

Question 40

how can marfans syndrome affect the lens?

Answer 40

it moves up

Question 41

5 features of pre-proliferative retinopathy?

Answer 41

``` cotton wool spots (soft exudates) >3 blot haemorrhages venous bleeding/looping deep/dark haemorrhages more common in type 1 ```

Question 42

2 features of proliferative retinopathy?

Answer 42

retinal neovascularization - leads to vitreous haemorrhage | fibrous tissue forming anterior to retinal disc

Question 43

mild NPDR?

Answer 43

1 or more microaneurysm

Question 44

moderate NPDR?

Answer 44

``` several microaneurysms blot haemorrhages hard exudates cotton wool spots venous beading/looping intra-retinal microvascular abnormalities (IRMA) - less severe than in severe NPDR ```

Question 45

severe NPDR?

Answer 45

blot haemorrhages and microaneurysms in 4 quadrants venous bleeding in at least 2 quadrants IRMA in at least 1 quadrant

Question 46

how does maculopathy present?

Answer 46

loss of central vision