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Opthamology > Eye in systemic disease - Neurology > Flashcards

Eye in systemic disease - Neurology Flashcards

1
Q

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

A

diabetic retinopathy

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2
Q

most common overall cause of blindness and partial sight?

A

ARMD

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3
Q

describe the pathogenesis of diabetic retinopathy

A

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

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4
Q

name 3 signs of background retinopathy

A

microaneurysms
blot haemorrhages
hard exudates

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5
Q

in what 3 places can new blood vessels grow?

A

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

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6
Q

what does the site of new vessel growth indicate?

A

where the damage is

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

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7
Q

what is rubeosis iridis?

A

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

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8
Q

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

A

haemorrhages
scarring/tractional retinal detachment
retinal oedema affecting the fovea

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9
Q

2 classifications of diabetic eye disease?

A

retinopathy

maculopathy

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10
Q

classifications of retinopathy?

A 
non-proliferative
- mild 
- moderate
- severe
proliferative
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11
Q

what are the stages of maculopathy?

A

no maculopathy
observable maculopathy
referable maculopathy
clinically significant maculopathy

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12
Q

what is maculopathy?

A

damage to the macula

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13
Q

how do you know if maculopathy is significant?

A

if macula is raised

needs 3D imaging

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14
Q

sign of previous laser eye surgery?

A

spots of yellowish colour all over eye

- laser changes composition of protein?

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15
Q

disc neovascularisation?

A

growth of new vessels in optic disc

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16
Q

how can proliferative disc neovascularisation be managed (diabetes)?

A

laser burns

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17
Q

management of maculopathy (diabetes)?

A

laser photocoagulation

anti VEGF injections

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18
Q

how can the eyes relate to hypertension?

A

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

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19
Q

signs of hypertensive retinopathy?

A

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

20
Q

presentation of accelerated hypertension?

A

usually young patients
very dramatic fundal appearance
can have decreased vision

21
Q

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

A

central retinal artery occlusion

22
Q

features of central retinal artery occlusion?

A

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

23
Q

4 signs of central retinal vein occlusion?

A

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

24
Q

what can cause central retinal vein occlusion?

A

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

25
Q

what is the worry in central retinal vein occlusion?

A

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

26
Q

features of branch vein occlusion?

A

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

27
Q

features of sarcoidosis

A

non-caseating granuloma
eye problems
bilateral hilar lymphadenopathy
erythema nodosum

28
Q

name 6 infective causes of uveitis

A 
TB
herpes zoster
toxoplasmosis
candidiasis
syphilis
lyme disease
29
Q

name 5 non-infective causes of uveitis

A 
HLA-B27 (most common)
idiopathic syndrome
juvenile arthritis (not RA)
sarcoidosis
Behcet's disease
30
Q

8 features of giant cell arteritis?

A 
inflammation of middle sized arteries
associated with polymyalgia rheumatica
headache
jaw claudication
malaise
raised PV (plasma viscosity)
raised alk phos
blinding condition
31
Q

how does giant cell arteritis affect the optic nerve head?

A

peripheral ciliary arteries are affected (not central retinal artery)

32
Q

proptosis/exopthalmus (bulging eyes) suggests what?

A

thyroid eye disease

33
Q

extraocular signs of thyroid eye disease?

A 
proptosis
lid signs
- retraction
- oedema
- lag
- pigmentation
restrictive myopathy
34
Q

ocular signs of thyroid eye disease?

A 
anterior segment
- chemosis
- injection
- exposure of cornea
- glaucoma
posterior segment
- choroidal folds
- optic nerve swelling
35
Q

swelling of the extraocular muscles and orbital fat suggest what?

A

thyroid eye disease

36
Q

management of thyroid eye disease?

A

control of thyroid dysfunction
lubricants
surgical decompression

37
Q

features of aye affected by SLE?

A

deep inflammation

red sclera

38
Q

what 3 affects can RA have on the eye?

A

dry eyes (keratoconjunctivitis sicca)
scleritis
corneal melt

39
Q

triad of features in sjogrens syndrome?

A

keratoconjunctivitis sicca
xerostomia
RA
also get infiltration of lacrimal glands

40
Q

how can marfans syndrome affect the lens?

A

it moves up

41
Q

5 features of pre-proliferative retinopathy?

A 
cotton wool spots (soft exudates)
>3 blot haemorrhages
venous bleeding/looping
deep/dark haemorrhages
more common in type 1
42
Q

2 features of proliferative retinopathy?

A

retinal neovascularization - leads to vitreous haemorrhage

fibrous tissue forming anterior to retinal disc

43
Q

mild NPDR?

A

1 or more microaneurysm

44
Q

moderate NPDR?

A 
several microaneurysms
blot haemorrhages
hard exudates
cotton wool spots
venous beading/looping
intra-retinal microvascular abnormalities (IRMA)
- less severe than in severe NPDR
45
Q

severe NPDR?

A

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

46
Q

how does maculopathy present?

A

loss of central vision

Opthamology (18 decks)

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