Non retinal ocular complications of diabetes Flashcards
list all 9 non retinal ocular complications of diabetes
CN palsies - 3rd, 4th and 6th
Chalazia
Corneal ulceration
Glaucoma
Cataracts e.g. snowflake
Refractive fluctuations
Rubeosis iridas
Vein occlusions
NAION
name the 3 types of cranial nerve palsies associated with diabetes
3rd Oculomotor
6th Abducens
4th Trochlear
what type of diplopia is present with 3rd nerve palsy
down and out
which type of diplopia is present in 6th nerve palsy
laterally in distance e.g. when driving - can see two roads etc
which type of diplopia is present with a 4th nerve palsy
dipl when e.g. doing down the stairs, need to tilt head when looking down
How do you manage a px presenting with a 3rd nerve palsy
it is dependent on pupil involvement.
no pupil involvement = routine referral, px will recover 6 months
pupil involvement = ocular emergency
why is a 3rd oculomotor nerve palsy with pupil involvement an ocular emergency
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!
how is a px with a 6th/abducens nerve palsy affected
they are unable to abduct the eye affected hence the person can have an esotropia as primary position in extreme cases
which extra ocular muscle is affected with a 4th/trochlear nerve palsy
superior oblique
why are diabetic people more at risk of developing a chalazion and what advice should you give them
as they are more at risk of getting infections
advise to treat any ongoing blepheritis
how are diabetic patients more at risk of developing corneal ulcers
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
how do you manage a diabetic px with relation to glaucoma
what should not be prescribed to them
IOP checks are important
Not to be prescribed timolol to tx glaucoma, better to take latanoprost instead
why should timolol NOT be prescribed to tx glaucoma for a diabetic px
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
which type of cataract is this and how is it treated
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
asides from poor blood glucose control, how else can a diabetic px develop a cataract earlier in life
if they are being treated for cmo with intravitreal injections
how can the iris become affected with a diabetic px
rubeosis iridas
should always check the iris before dilating a px due to proliferative DR or ischaemic branch or central vein occlusions
what test must be conducted when a px is found to have a brvo or crvo
a vascular work up - px to have a fasting blood sugar test to rule out DM as there is a strong association
what is Non Arteritic Ischaemic Optic Neuropathy NAION and how can this happen
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
what symptoms does NAION cause and which type of people does it usually affect
Sudden, painless loss of vision, usually noticed in the morning
Can progressively worsen
Patients usually > 45yrs Arteriopaths
which 2 clinical signs can be seen with a px who has NAION
Altitudinal field defect
Diffuse or segmental disc swelling
Hemorrhages & CWS
what 2 types of optic discs are more likely to develop NAION
Small discs or discs with drusen have an increased risk of NAION
disc at risk = small crowded disc
how does the optic disc appear post NAION and what tx is given to these px’s and why
Within 6 to 12 weeks segmental disc pallor
Antiplatelet drugs are given prophylactically - to prevent against systemic cardiovascular conditions
