Eyes and systemic disease

Question 1

what groups of diseases can cause eye problems

Answer 1

diabetes
hypertension
connective tissue diseases - SLE, RA, Marfans
inflammatory diseases - GCA, thyroid

Question 2

What is the most important CVS disease of the eye

Answer 2

diabetic retinopathy

Question 3

What eye diseases can DM cause

Answer 3

retinopathy

maculopathy

Question 4

pathogenesis of diabetic retinopathy

Answer 4

chronic hyperglycaemia causes glycosylation of protein/BM resulting in loss of pericytes (cells that surround endothelium) which results in microaneurysms which can leak and cause ischaemia

Question 5

What are the categories of diabetic retinopathy

Answer 5

non-proliferative
- mild 
- moderate 
- severe 
Proliferative

Question 6

what does proliferative retinopathy essentially mean

Answer 6

neovascularisation

Question 7

signs of non-proliferative diabetic retinopathy

Answer 7

microaneurysms 
dot + blot haemorrhages 
hard exudate
cotton wool patches 
abnormalities of venous calibre 
intra-retinal microvascular abnormalities (IRMA)

Question 8

what are hard exudates

Answer 8

products of lipid breakdown

Question 9

what are cotton wool patches

Answer 9

white fluffy areas from ischaemia and oedema of axon layer of retina

Question 10

what is IRMA

Answer 10

intra retinal microvascular abnormalities are a precursor to neovascularisation

Question 11

what causes neovascularisation

Answer 11

ischaemia drives VEGF to cause neovascularisation

Question 12

Where can neovascularisation occur

Answer 12

disc NVD
periphery NVE
iris - rubeosis iridis

Question 13

causes of vision loss in diabetic patients

Answer 13

retinal oedema affecting fovea
vitreous haemorrhage
retinal detachment

Question 14

How can you classify maculopathy

Answer 14

none
observable
referrable
clinically significant

Question 15

true or false, the retina is transparent

Answer 15

true, it appears pink becuase of the choroid layer beneath it

Question 16

in maculopathy, central/peripheral vision is damaged?

Answer 16

central

Question 17

what investigation is used to observe maculopathy

Answer 17

OCT - optical coherence tomography

Question 18

Management of diabetic eye disease

Answer 18

optimise diabetic control
laser - PRP (pan retinal photocoagulation)
surgery - vitrectomy
rehabilitation

Question 19

what does lasering the retina do

Answer 19

reducing O2 demand of the eye and making it less hypoxic

Question 20

management of neovascularisation around the macula

Answer 20

anti VEGF injections

since lasering is riskier

Question 21

appearance of the eye after lasering
fresh
old

Answer 21

fresh - white

old - dark

Question 22

in hypertensive retinopathy, appearance of fundus correlates to severity of hypertension and the state of retinal arterioles, true or false

Answer 22

true

Question 23

what sign is characteristic of hypertensive and DM retinopathy

Answer 23

cotton wool spots

Question 24

signs of hypertensive retinopathy

Answer 24

attenuated blood vessels - silver/copper wiring 
hard exudates 
cotton wool spots 
retinal haemorrhages 
optic disc oedema
AV nipping

Question 25

features of CRAO

Answer 25

``` sudden painless loss of vision white oedematous retina no necrosis from choroid collateral supply Cherry red spot at fovea rarely recovers ```

Question 26

features of CRVO

Answer 26

sudden painless loss of vision | range of visual loss

Question 27

How can arterial damage and atherosclerosis lead to CRVO

Answer 27

artery walls become thicker and atherosclerotic which impinges adjacent vein therefore occluding it

Question 28

what are the 2 main causes of uveitis

Answer 28

infective and non-infective

Question 29

list infective causes of uveitis

Answer 29

``` TB HZV toxoplasmosis candidiasis syphilis Lyme disease ```

Question 30

list non-infective causes of uveitis

Answer 30

``` sarcoidosis IBD Behcets HLA B27 juvenile arthritis idiopathic ```

Question 31

symptoms of GCA with polymylagia rheumatica

Answer 31

``` loss of vision temporal scalp tenderness jaw claudication headache malaise proximal muscle stiffness and pain ```

Question 32

GCA only affects arteries with an internal elastic lamina, true or false

Answer 32

true | therefore retinal arteries are unaffected

Question 33

how can features of thyroid eye disease (TED) be grouped

Answer 33

extraocular | ocular

Question 34

extraocular features of TED

Answer 34

proptosis lid retraction, oedema, lag, pigmentation restrictive myopathy (EOM)

Question 35

ocular features of TED

Answer 35

``` anterior segment - chemosis injected vessels glaucoma diplopia posterior segment - optic nerve swelling ```

Question 36

ocular manifestations of SLE

Answer 36

scleritis ocular inflammation necrosis and perforation

Question 37

ocular manifestations of rheumatoid arthritis

Answer 37

keratoconjunctivitis sicca - dry scleritis corneal melt

Question 38

RA gives you intra/extra ocular disease

Answer 38

extra ocular disease

Question 39

ocular manifestations of Sjögrens syndrome

Answer 39

keratoconjunctivitis sicca (also xerostomia) infiltration of lacrimal gland

Question 40

ocular manifestations of Marfans syndrome

Answer 40

upward lens discolation

Question 41

in other conditions, the lens usually displaces downwards apart from in Marfans which displaces upwards, true or false

Answer 41

true