Manifestations of Systemic Disease

Question 1

Traumatic disorder is a manifestation associated with?

Answer 1

Shaken baby syndrome and is characterized by intraretinal, or vitreous hemorrhages

Question 2

Hypertensive Retinopathy

Answer 2

A manifestation of prolonged hypertensive effects on the eye. Can be categorized into three classes: Mild, Moderate, and Severe.

Question 3

What are mild Hypertensive Retinopathy (signs)

Answer 3

Retinal artery narrowing (Due to vasospasm)
Arterial wall thickening or opacification
Arteriovenous nicking—referred to as “nipping”

Question 4

Hypertensive Retinopathy (symptoms)

Answer 4

vision normal; blurred or sudden decrease; scotoma; diploplia

Question 5

Intercranial Hypertension

Answer 5

optic disc swelling—papilledema. mild blurring to complete visual loss, usually lasting only a few seconds. Fundascopic exam typically reveals marked disc swelling and vascular engorgement

Question 6

Graves Opthalmopathy

Answer 6

Occurs in about 20% of patient’s with Grave’s disease (hyperthyroid condition). More common in women. Smoking is a risk factor for developing

Question 7

Physical exam of Graves

Answer 7

See lid lag and stare. Determine the extent which upper/lower lids can be closed. Assess EOM range of motion. Measure proptosis using exophthalmometer. Evaluate visual acuity, color vision, and visual fields

Question 8

Myasthenia Gravis (treatment)

Answer 8

Symptomatic—anticholinesterase meds. Chronic immunomodulating. Rapid immunomodulating. Surgical—remove thymus

Question 9

HIV effects on the eye

Answer 9

common finding- cotton wool spots. Can lead to infections (CMV retinitis/Toxoplasmosis) and karposi sarcoma

Question 10

Toxoplasmosis Retinitis

Answer 10

Potentially blinding, necrotizing retinitis. May see old scars on retina. Presents with: wavy or distorted vision (metamorphopsia), floaters, pain-variable, decreased or blurred vision

Question 11

Cause of DM blindness

Answer 11

Leading cause of adult blindness in the US. In chronic hyperglycemia—excess glucose binds with free amino acids forming irreversible advanced glycolsylation end products (AGEs)

Question 12

Treatment for Proliferative Diabetic Retinopathy

Answer 12

Photocoagulation for Proliferative Diabetic Retinopathy - lazer creates scar tissue to disuade development of disease. growth factor inhibitors. tight glycemic control

Question 13

What are moderate hypertensive retinopathy signs?

Answer 13

Hemorrhages—either flame or dot shaped. Cotton-wool spots. Hard exudates. Microaneurysms

Question 14

Herpes Zoster infection

Answer 14

commonly associated with HIV/AIDS and pregnant women. acute retinal necrosis (refer)

Question 15

Sjogrens Syndrome

Answer 15

Inflammatory infiltration of lacrimal glands:Leads to cell death. Then tear hyposecretion. Causing keratoconjunctivitis sicca

Question 16

What are severe signs of hypertensive retinopathy?

Answer 16

Some or all of the mild/moderate signs.Plus optic disc edema. Presence of papilledema MANDATES lowering of the BP!!!

Question 17

What is the role of vascular endothelial growth factor in eye disease?

Answer 17

is synthesized in the retina and can be excessively synthesized leading to the overgrowth of new blood vessels

Question 18

proliferative retinopathy

Answer 18

Responsible for the most devastating visual loss in DM. Vitreous hemorrhage, and tractional retinal detachment

Question 19

What are some common causes of intracranial HTN?

Answer 19

brain tumor. venous sinus thrombosis. Meningitis. Hydrocephalus. pseudotumor cerebri. Tetracycline therapy. Steroid withdrawal

Question 20

What is the most commonly affected muscle with Grave’s opthalamopathy?

Answer 20

inferior rectus. results in restricted upward gaze and vertical diplopia.

Question 21

What is treatment for proptosis caused by Graves?

Answer 21

lubricating ointment ans and tape eyelids shut at night. Artificial tears during day. prevent dry eyes and corneal ulceration

Question 22

What is seen with ocular myasthenia gravis?

Answer 22

Ptosis fluctuation & oculomotor paresis: Fatigability of the levator muscle and ophthalmoparesis results in binocular diplopia

Question 23

What is the most common ocular complication of AIDS?

Answer 23

CMV retinitis- leads to retinal detachment

Question 24

What are signs of early nonproliferative DM retinopathy?

Answer 24

microaneurysms, and intraretinal hemorrhages. Cotton wool spots. Visual acuity is usually unaffected unless these findings involve the macula and cause macular edema.

Question 25

What are symptoms of CMV retinitis?

Answer 25

floaters, decreased or blurred vision, scotoma, photopsia (“flashing lights”),

Question 26

What are treatment methods of CMV retinitis?

Answer 26

anti-HIV meds, IV or intravitrial antivirals (such as ganciclovir) or implants of drug

Question 27

What are treatment methods for toxoplasmosis retinitis?

Answer 27

pyramethamine and folate, sulfisoxazole, clindamycen (“Triple therapy”) + prednisone

Question 28

What are symptoms of DM retinopathy?

Answer 28

some patients w/ severe disease can have 20/20 vision. blurring slowly or suddenly. visual distortion (things may appear crooked or wavy). floaters which can be from vitreous hemorrhage—described as “shower”. scotomata

Question 29

What are signs of advance nonproliferative DM retinopathy?

Answer 29

Findings include cotton wool spots and extensive retinal hemorrhages.

Question 30

Describe photocoagulation as a treatment method

Answer 30

The laser is used to place 1000-2000 burns in an evenly distributed scatter-pattern across the entire retina except at the macula. These burns ablate the retinal tissue and cause the proliferating vessels to disappear

Question 31

What are the surgical treatments of proliferative DR?

Answer 31

vitrectomy-Used to remove nonclearing vitreous hemorrhage and to treat or prevent retinal detachment.Vitreous removed, fibrous bands are cut, and endophotocoagulation may be performed to destroy new retinal vessels

Question 32

What are cotton wool spots?

Answer 32

retinal nerve fiber layer microinfarcts

Question 33

What are hard exudates?

Answer 33

(lipid residue from serous leakage from damaged capillaries)