Non retinal ocular complications of diabetes

Question 1

list all 9 non retinal ocular complications of diabetes

Answer 1

CN palsies - 3rd, 4th and 6th

Chalazia

Corneal ulceration

Glaucoma

Cataracts e.g. snowflake

Refractive fluctuations

Rubeosis iridas

Vein occlusions

NAION

Question 2

name the 3 types of cranial nerve palsies associated with diabetes

Answer 2

3rd Oculomotor
6th Abducens
4th Trochlear

Question 3

what type of diplopia is present with 3rd nerve palsy

Answer 3

down and out

Question 4

which type of diplopia is present in 6th nerve palsy

Answer 4

laterally in distance e.g. when driving - can see two roads etc

Question 5

which type of diplopia is present with a 4th nerve palsy

Answer 5

dipl when e.g. doing down the stairs, need to tilt head when looking down

Question 6

How do you manage a px presenting with a 3rd nerve palsy

Answer 6

it is dependent on pupil involvement.

no pupil involvement = routine referral, px will recover 6 months

pupil involvement = ocular emergency

Question 7

why is a 3rd oculomotor nerve palsy with pupil involvement an ocular emergency

Answer 7

may indicate an aneurysm pressing on the posterior communicating artery and on the anterior communicating artery which becomes a surgical emergency

so must always check the pupils!

Question 8

how is a px with a 6th/abducens nerve palsy affected

Answer 8

they are unable to abduct the eye affected hence the person can have an esotropia as primary position in extreme cases

Question 9

which extra ocular muscle is affected with a 4th/trochlear nerve palsy

Answer 9

superior oblique

Question 10

why are diabetic people more at risk of developing a chalazion and what advice should you give them

Answer 10

as they are more at risk of getting infections

advise to treat any ongoing blepheritis

Question 11

how are diabetic patients more at risk of developing corneal ulcers

Answer 11

they have reduced corneal sensitivity, so ulcers can progress more rapidly

if a px has poor diabetic control - they shouldn’t wear cont wear CLS as increased risk of infection

Question 12

how do you manage a diabetic px with relation to glaucoma

what should not be prescribed to them

Answer 12

IOP checks are important

Not to be prescribed timolol to tx glaucoma, better to take latanoprost instead

Question 13

why should timolol NOT be prescribed to tx glaucoma for a diabetic px

Answer 13

when sugars begin to fall and a person becomes hypoglycaemic, adrenalin is then released which alerts the px that their sugars are low, which will prompt them to have a sugary drink.

However if on timolol/beta blockers, this response is neutralised hence making it dangerous

Question 14

which type of cataract is this and how is it treated

Answer 14

snowflake cataract

due to high blood sugar levels

this can be reversed when sugars are under control, hence can be treated conservatively and not surgically

Question 15

asides from poor blood glucose control, how else can a diabetic px develop a cataract earlier in life

Answer 15

if they are being treated for cmo with intravitreal injections

Question 16

how can the iris become affected with a diabetic px

Answer 16

rubeosis iridas

should always check the iris before dilating a px due to proliferative DR or ischaemic branch or central vein occlusions

Question 17

what test must be conducted when a px is found to have a brvo or crvo

Answer 17

a vascular work up - px to have a fasting blood sugar test to rule out DM as there is a strong association

Question 18

what is Non Arteritic Ischaemic Optic Neuropathy NAION and how can this happen

Answer 18

Infarction of the short ciliary arteries

overnight, the bp tends to be lower and can get episodes of hypo perfusion of the short ciliary arteries causing subsequent ischaemia of the optic nerve = a fall in vision

Question 19

what symptoms does NAION cause and which type of people does it usually affect

Answer 19

Sudden, painless loss of vision, usually noticed in the morning
Can progressively worsen

Patients usually > 45yrs Arteriopaths

Question 20

which 2 clinical signs can be seen with a px who has NAION

Answer 20

Altitudinal field defect

Diffuse or segmental disc swelling
Hemorrhages & CWS

Question 21

what 2 types of optic discs are more likely to develop NAION

Answer 21

Small discs or discs with drusen have an increased risk of NAION
disc at risk = small crowded disc

Question 22

how does the optic disc appear post NAION and what tx is given to these px’s and why

Answer 22

Within 6 to 12 weeks segmental disc pallor

Antiplatelet drugs are given prophylactically - to prevent against systemic cardiovascular conditions