Eyes and systemic disease Flashcards
what groups of diseases can cause eye problems
diabetes
hypertension
connective tissue diseases - SLE, RA, Marfans
inflammatory diseases - GCA, thyroid
What is the most important CVS disease of the eye
diabetic retinopathy
What eye diseases can DM cause
retinopathy
maculopathy
pathogenesis of diabetic retinopathy
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
What are the categories of diabetic retinopathy
non-proliferative - mild - moderate - severe Proliferative
what does proliferative retinopathy essentially mean
neovascularisation
signs of non-proliferative diabetic retinopathy
microaneurysms dot + blot haemorrhages hard exudate cotton wool patches abnormalities of venous calibre intra-retinal microvascular abnormalities (IRMA)
what are hard exudates
products of lipid breakdown
what are cotton wool patches
white fluffy areas from ischaemia and oedema of axon layer of retina
what is IRMA
intra retinal microvascular abnormalities are a precursor to neovascularisation
what causes neovascularisation
ischaemia drives VEGF to cause neovascularisation
Where can neovascularisation occur
disc NVD
periphery NVE
iris - rubeosis iridis
causes of vision loss in diabetic patients
retinal oedema affecting fovea
vitreous haemorrhage
retinal detachment
How can you classify maculopathy
none
observable
referrable
clinically significant
true or false, the retina is transparent
true, it appears pink becuase of the choroid layer beneath it
in maculopathy, central/peripheral vision is damaged?
central
what investigation is used to observe maculopathy
OCT - optical coherence tomography
Management of diabetic eye disease
optimise diabetic control
laser - PRP (pan retinal photocoagulation)
surgery - vitrectomy
rehabilitation
what does lasering the retina do
reducing O2 demand of the eye and making it less hypoxic
management of neovascularisation around the macula
anti VEGF injections
since lasering is riskier
appearance of the eye after lasering
fresh
old
fresh - white
old - dark
in hypertensive retinopathy, appearance of fundus correlates to severity of hypertension and the state of retinal arterioles, true or false
true
what sign is characteristic of hypertensive and DM retinopathy
cotton wool spots
signs of hypertensive retinopathy
attenuated blood vessels - silver/copper wiring hard exudates cotton wool spots retinal haemorrhages optic disc oedema AV nipping
features of CRAO
sudden painless loss of vision white oedematous retina no necrosis from choroid collateral supply Cherry red spot at fovea rarely recovers
features of CRVO
sudden painless loss of vision
range of visual loss
How can arterial damage and atherosclerosis lead to CRVO
artery walls become thicker and atherosclerotic which impinges adjacent vein therefore occluding it
what are the 2 main causes of uveitis
infective and non-infective
list infective causes of uveitis
TB HZV toxoplasmosis candidiasis syphilis Lyme disease
list non-infective causes of uveitis
sarcoidosis IBD Behcets HLA B27 juvenile arthritis idiopathic
symptoms of GCA with polymylagia rheumatica
loss of vision temporal scalp tenderness jaw claudication headache malaise proximal muscle stiffness and pain
GCA only affects arteries with an internal elastic lamina, true or false
true
therefore retinal arteries are unaffected
how can features of thyroid eye disease (TED) be grouped
extraocular
ocular
extraocular features of TED
proptosis
lid retraction, oedema, lag, pigmentation
restrictive myopathy (EOM)
ocular features of TED
anterior segment - chemosis injected vessels glaucoma diplopia posterior segment - optic nerve swelling
ocular manifestations of SLE
scleritis
ocular inflammation
necrosis and perforation
ocular manifestations of rheumatoid arthritis
keratoconjunctivitis sicca - dry
scleritis
corneal melt
RA gives you intra/extra ocular disease
extra ocular disease
ocular manifestations of Sjögrens syndrome
keratoconjunctivitis sicca
(also xerostomia)
infiltration of lacrimal gland
ocular manifestations of Marfans syndrome
upward lens discolation
in other conditions, the lens usually displaces downwards apart from in Marfans which displaces upwards, true or false
true
