Ocular Manifestations of Systemic Disease Flashcards
What is this?`
- Nonproliferative diabetic retinopathy/pre-proliferative retinopathy: First ocular manifestation of T2DM is microaneurysm formation
- Capillary leak and later become occluded
(This also shows maculopathy)
T2DM 2/circinate retinopathy (aka nonproliferative diabetic retinopathy (NPDR) or pre-proliferative: what are the typical signs and symptoms (4)?
- Dot and blot hemorrhages
- Hard exudates
- Cotton wool spots (infarct of optic nerve fiber)
- Macular edema
(circinate = circular shape)
What is this?
(hint: it is the leading cause of blindness in diabetic patients)
Proliferative Diabetic Retinopathy (PDR): neovascularization over the optic disc (NVD) or elsewhere (NVE) on the retinal surface
(this photo is NVE, may also happen on iris → glaucoma)
Where in the photo is the neovascularization? Treatment?
- The superior aspect of the right optic nerve
- Panretinal photocoagulation
What is this? What stage (pathogenesis?)
- proliferative diabetic retinopathy
- New vascularization to the point that vessels bleed into the vitreous
(proteins are also formed in neovascularization, they may contract and detach the retina)
What is the surgical treatment of proliferative diabetic retinopathy (shown) with tractional retinal detachment (not in photo)?
vitrectomy (laser surgery)
What is this? How does it work?
Other treatment options?
- panretinal photocoagulation trmt of proliferative diabetic retinopathy: 1k-2k laser burns on retina, outside of vascular arcades → reduces metabolic O2 requirement needed of retina or destroys VEGF-secreting cells → regression of neovascular tissue
- Intravitreal local ranibizumab (Lucentis) injections
T2DM standard of care (ophthalmologically)
dilated exam of fundus once per year minimum
What is this?
Lower arrows?
Upper arrows?
- Hypertensive retinopathy (long-standing hypertension)
- copper wiring (vessels clogged w/plaque) & silver wiring (completely obstructed)
- A/V crossing changes
What is this? What causes this?
Hypersensitive retinopathy with cotton wool spots
severe A/V nicking (vein is pinched as it crosses the artery) → branch retinal vein occlusion (BRVO)→ appears as cotton wool spots or hemorrhage in the sector that is drained by the affected vein
Unlike Branch retinal vein occlusion (BRVO), Branch retinal artery occlusion (BRAO) and Central retinal artery occlusion (CRAO) are usually the result of ______.
systemic embolism from the Carotid system of the heart
Older patients with Central retinal artery occlusion (CRAO) should be screened for signs and symptoms of ______. What lab work is ordered (3)?
- giant cell arteritis
- emergent sed rate (ESR)
- C-reactive protein (CRP)
- temporal artery biopsy
What is this?
What can be seen on fundoscopic exam?
- Severe Hypertensive retinopathy
- Fibrinoid necrosis of the vessel wall → exudates, cotton-wool spots, flame-shaped hemorrhages, subretinal fluid
Ophthalmic findings in hypertension (4)
- Arteriolar Sclerosis
- A-V nicking/crossing changes
- Copper-wiring of arterioles
- Silver-wiring of arterioles
(May lead to branch retinal vein occlusion (BRVO))
What is this? What can be visualized on fundoscopic exam?
- Malignant hypertension retinopathy
- Optic disc swelling (similar to papilledema), exudates that may assume a stellate configuration in the outer plexiform layer of Henley (“macular star”)
Sickle-cell retinopathy: 3 causes
- HbSC disease (most common form)
- HbSS disease
- Sickle thalassemia
Of the three Sickle Cell retinopathies, which one(s) is(are) more likely to be involved with ocular manifestations?
- Sickle Cell Hemoglobin C
- Sickle Cell thalassemia
(as with diabetes, inadequate perfusion of the retina can stimulate neovascularization)
Thyroid eye disease: characteristics seen upon examination (2)
- Eyelid retraction of the upper or lower eyelids
- Fibrosis and restriction of extraocular muscles
Fibrosis and restriction of extraocular muscles: 2 most common muscles involved?
- Inferior rectus (can’t look down)
- Medial rectus
(patient presents w/head extended to correct)
Sarcoidosis most commonly affects which population
African-Americans and Hispanics
(ocular involvement in about 25% of patients)
What is this? Caused by?
- Mutton-fats keratic precipitates in sarcoidosis
- sarcoidosis: chronic autoimmune disease
(may cause anterior or posterior uveitis)
CD4 counts below_____ cells/mL puts patients at risk for _____.
- 100 cells/mL
- CMV retinitis
(cell counts above 100 cells per milliliter leave a patient susceptible to other infections such as syphilis)
refer to ophthalmologist
What is this? It is due to ________ of the pre capillary retinal arterioles that result in ______.
- retinal cotton-wool spots
- axoplasmic stasis of the retinal nerve fiber axons
(these are usually the sole ocular finding in patients with AIDS. Occlusions are thought to be from micro thrombi from antigen-antibody complexes and fibrin)
refer to ophthalmologist
What is the leading cause a visual loss in patients with AIDS? Characterization?
- CMV retinitis
- Sectional sectoral hemorrhagic necrosis of the retina (along vessels), distinct borders abruptly abut normal areas of retina
refer to ophthalmologist
Herpes zoster ophthalmicus: treatment regimen
- Acyclovir 800 mg five times per day for 7 to 10 days
- 48 hours from onset of symptoms preferable
(look for lesion of the tip of the nose which indicates nasociliary nerve involvement)
Any patient with an autoimmune disease or systemic infection who presents with a ________ (4) should be referred to an ophthalmologist for a slit-lamp examination to look for subtle but vision-threatening intraocular inflammation.
(TQ!!)
- decreased vision
- floaters
- red eye
- photophobia
________ is the first ocular manifestation of T2DM
- Non proliferative diabetic retinopathy microaneurysm formation
Rheumatoid Arthritis (RA) ocular manifestations (5)
- Corneal ulcer
- Dry eyes
- Episcleritis
- Scleritis
- Uveitis
