Eye in systemic disease - Neurology Flashcards
most common cause of blindness and partial sight in 16-64 yr olds?
diabetic retinopathy
most common overall cause of blindness and partial sight?
ARMD
describe the pathogenesis of diabetic retinopathy
chronic hyperglycaemia > glycosylation of protein/basement membrane > loss of pericytes > microaneurysm > leakage or ischaemia from abnormal vessels
name 3 signs of background retinopathy
microaneurysms
blot haemorrhages
hard exudates
in what 3 places can new blood vessels grow?
grow on disc (NVD)
grow in periphery (NVE)
grow on iris if ischaemia is severe
what does the site of new vessel growth indicate?
where the damage is
i.e - new vessel growth at the disc indicates vascular damage at the central retinal artery etc
what is rubeosis iridis?
vessel growth into the iris
no sight restoration
leads to glaucoma etc
diabetic patients lose vision as a result of what 3 processes?
haemorrhages
scarring/tractional retinal detachment
retinal oedema affecting the fovea
2 classifications of diabetic eye disease?
retinopathy
maculopathy
classifications of retinopathy?
non-proliferative - mild - moderate - severe proliferative
what are the stages of maculopathy?
no maculopathy
observable maculopathy
referable maculopathy
clinically significant maculopathy
what is maculopathy?
damage to the macula
how do you know if maculopathy is significant?
if macula is raised
needs 3D imaging
sign of previous laser eye surgery?
spots of yellowish colour all over eye
- laser changes composition of protein?
disc neovascularisation?
growth of new vessels in optic disc
how can proliferative disc neovascularisation be managed (diabetes)?
laser burns
management of maculopathy (diabetes)?
laser photocoagulation
anti VEGF injections
how can the eyes relate to hypertension?
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
signs of hypertensive retinopathy?
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
presentation of accelerated hypertension?
usually young patients
very dramatic fundal appearance
can have decreased vision
cattle-trucking of vessels and white retina with sparing of fovea are signs of what?
central retinal artery occlusion
features of central retinal artery occlusion?
sudden painless loss of vision
very profound loss of vision
retinal nerve fibre layer becomes swollen except at fovea (cherry red spot)
rarely recovers
4 signs of central retinal vein occlusion?
sudden painless visual loss
range of visual loss
need to determine degree of ischaemia
ischaemia correlates to degree of reduced vision and fundal appearence
what can cause central retinal vein occlusion?
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
what is the worry in central retinal vein occlusion?
rubeotic eye
- growth of vessels in iris
basically end game, nothing you can do for it
features of branch vein occlusion?
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
features of sarcoidosis
non-caseating granuloma
eye problems
bilateral hilar lymphadenopathy
erythema nodosum
name 6 infective causes of uveitis
TB herpes zoster toxoplasmosis candidiasis syphilis lyme disease
name 5 non-infective causes of uveitis
HLA-B27 (most common) idiopathic syndrome juvenile arthritis (not RA) sarcoidosis Behcet's disease
8 features of giant cell arteritis?
inflammation of middle sized arteries associated with polymyalgia rheumatica headache jaw claudication malaise raised PV (plasma viscosity) raised alk phos blinding condition
how does giant cell arteritis affect the optic nerve head?
peripheral ciliary arteries are affected (not central retinal artery)
proptosis/exopthalmus (bulging eyes) suggests what?
thyroid eye disease
extraocular signs of thyroid eye disease?
proptosis lid signs - retraction - oedema - lag - pigmentation restrictive myopathy
ocular signs of thyroid eye disease?
anterior segment - chemosis - injection - exposure of cornea - glaucoma posterior segment - choroidal folds - optic nerve swelling
swelling of the extraocular muscles and orbital fat suggest what?
thyroid eye disease
management of thyroid eye disease?
control of thyroid dysfunction
lubricants
surgical decompression
features of aye affected by SLE?
deep inflammation
red sclera
what 3 affects can RA have on the eye?
dry eyes (keratoconjunctivitis sicca)
scleritis
corneal melt
triad of features in sjogrens syndrome?
keratoconjunctivitis sicca
xerostomia
RA
also get infiltration of lacrimal glands
how can marfans syndrome affect the lens?
it moves up
5 features of pre-proliferative retinopathy?
cotton wool spots (soft exudates) >3 blot haemorrhages venous bleeding/looping deep/dark haemorrhages more common in type 1
2 features of proliferative retinopathy?
retinal neovascularization - leads to vitreous haemorrhage
fibrous tissue forming anterior to retinal disc
mild NPDR?
1 or more microaneurysm
moderate NPDR?
several microaneurysms blot haemorrhages hard exudates cotton wool spots venous beading/looping intra-retinal microvascular abnormalities (IRMA) - less severe than in severe NPDR
severe NPDR?
blot haemorrhages and microaneurysms in 4 quadrants
venous bleeding in at least 2 quadrants
IRMA in at least 1 quadrant
how does maculopathy present?
loss of central vision
