Manifestations of Systemic Disease Flashcards
Traumatic disorder is a manifestation associated with?
Shaken baby syndrome and is characterized by intraretinal, or vitreous hemorrhages
Hypertensive Retinopathy
A manifestation of prolonged hypertensive effects on the eye. Can be categorized into three classes: Mild, Moderate, and Severe.
What are mild Hypertensive Retinopathy (signs)
Retinal artery narrowing (Due to vasospasm)
Arterial wall thickening or opacification
Arteriovenous nicking—referred to as “nipping”
Hypertensive Retinopathy (symptoms)
vision normal; blurred or sudden decrease; scotoma; diploplia
Intercranial Hypertension
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
Graves Opthalmopathy
Occurs in about 20% of patient’s with Grave’s disease (hyperthyroid condition). More common in women. Smoking is a risk factor for developing
Physical exam of Graves
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
Myasthenia Gravis (treatment)
Symptomatic—anticholinesterase meds. Chronic immunomodulating. Rapid immunomodulating. Surgical—remove thymus
HIV effects on the eye
common finding- cotton wool spots. Can lead to infections (CMV retinitis/Toxoplasmosis) and karposi sarcoma
Toxoplasmosis Retinitis
Potentially blinding, necrotizing retinitis. May see old scars on retina. Presents with: wavy or distorted vision (metamorphopsia), floaters, pain-variable, decreased or blurred vision
Cause of DM blindness
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)
Treatment for Proliferative Diabetic Retinopathy
Photocoagulation for Proliferative Diabetic Retinopathy - lazer creates scar tissue to disuade development of disease. growth factor inhibitors. tight glycemic control
What are moderate hypertensive retinopathy signs?
Hemorrhages—either flame or dot shaped. Cotton-wool spots. Hard exudates. Microaneurysms
Herpes Zoster infection
commonly associated with HIV/AIDS and pregnant women. acute retinal necrosis (refer)
Sjogrens Syndrome
Inflammatory infiltration of lacrimal glands:Leads to cell death. Then tear hyposecretion. Causing keratoconjunctivitis sicca
What are severe signs of hypertensive retinopathy?
Some or all of the mild/moderate signs.Plus optic disc edema. Presence of papilledema MANDATES lowering of the BP!!!
What is the role of vascular endothelial growth factor in eye disease?
is synthesized in the retina and can be excessively synthesized leading to the overgrowth of new blood vessels
proliferative retinopathy
Responsible for the most devastating visual loss in DM. Vitreous hemorrhage, and tractional retinal detachment
What are some common causes of intracranial HTN?
brain tumor. venous sinus thrombosis. Meningitis. Hydrocephalus. pseudotumor cerebri. Tetracycline therapy. Steroid withdrawal
What is the most commonly affected muscle with Grave’s opthalamopathy?
inferior rectus. results in restricted upward gaze and vertical diplopia.
What is treatment for proptosis caused by Graves?
lubricating ointment ans and tape eyelids shut at night. Artificial tears during day. prevent dry eyes and corneal ulceration
What is seen with ocular myasthenia gravis?
Ptosis fluctuation & oculomotor paresis: Fatigability of the levator muscle and ophthalmoparesis results in binocular diplopia
What is the most common ocular complication of AIDS?
CMV retinitis- leads to retinal detachment
What are signs of early nonproliferative DM retinopathy?
microaneurysms, and intraretinal hemorrhages. Cotton wool spots. Visual acuity is usually unaffected unless these findings involve the macula and cause macular edema.
What are symptoms of CMV retinitis?
floaters, decreased or blurred vision, scotoma, photopsia (“flashing lights”),
What are treatment methods of CMV retinitis?
anti-HIV meds, IV or intravitrial antivirals (such as ganciclovir) or implants of drug
What are treatment methods for toxoplasmosis retinitis?
pyramethamine and folate, sulfisoxazole, clindamycen (“Triple therapy”) + prednisone
What are symptoms of DM retinopathy?
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
What are signs of advance nonproliferative DM retinopathy?
Findings include cotton wool spots and extensive retinal hemorrhages.
Describe photocoagulation as a treatment method
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
What are the surgical treatments of proliferative DR?
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
What are cotton wool spots?
retinal nerve fiber layer microinfarcts
What are hard exudates?
(lipid residue from serous leakage from damaged capillaries)
