Ocular Manifestations of Systemic Disease Flashcards
Traumatic Disorder
- Shaken baby syndrome is increasingly evident in our society.
- Fundoscopy may reveal preretinal, intraretinal or vitreous hemorrhages.
Hypertensive Retinopathy
- Occurs in 15% of patients with just HTN.
- Rarely by itself causes significant vision loss.
Hypertensive changes in the eye (Mild)
- Retinal artery narrowing
- Arterial wall thickening or opacification
- Arteriovenous nicking (nipping)
Hypertensive changes in the eye (Moderate)
- Hemmorhages: flame or dot shaped
- Cotton-wool spots
- Hard exudates
- Microaneurysms
Hypertensive changes in the eye (Severe)
- Some or all of moderate
- Optic disc edema
- Presence of papilledema mandates lowering of the BP!
Focal narrowing, exudates and flame hemorrhages are related to _________ BP levels
Current
Copper wire
Arteriolar sclerotic changes with arteriolar narrowing.
A long-lasting HTN ocular effect.
Silver wire
With halogen light source, sclerosis of vessel is seen. Appears white.
HTN retinopathy S/S
Sx:
- Normal vision, turning to a blurred or sudden decrease.
- Scotoma, diploplia
Signs: Ateriolar narrowing in chronic HTN
- Focal spasm in acute
- Retinal edema
- Microaneurysm
HTN retinopathy treatment
- Control HTN
- Manage renal disease associated w/ HTN.
- Refer to optho
Swelling of the optic disc
- Hallmark of malignant HTN.
- A sudden drop in perfusion can result in optic disc infarction and blindness.
- BP must be controlled immediately.
Intracranial HTN
- Most common ocular manifestation is optic disc swelling (papilledema)
- Transient visual symptoms
Grave’s Opthalmopathy
- Occurs in about 20% of patients w/ grave’s.
- More common in women
- Smoking is a risk factor
Grave’s O Patho
T lymphocytes cause inflammation and accumulation of hydrophilic glycosaminoglycans (GAG).
- Restricts upward gaze
- Results in vertical diploplia
Grave’s O S/S
Signs:
- Proptosis (exopthalmus)
- Preorbital Edema
VIsual Symptoms:
-Excessive tearing, eye pain, blurred vision, diploplia, occasional loss of vision
Grave’s O complications
Exopthalmus
Dry eyes, corneal ulceration
EOM impairment
-Diploplia, no upward vision, cannot achieve or maintain convergence.
Tx of Grave’s O
Treat underlying Hypothyroidism
Mild:
-Dark glasses, artificial tears, elevate head, Oral selenium.
Severe:
-Glucocorticoids, Radiation or surgery.
Ocular Myasthenia Gravis
- Autoimmune disorder characterized by weakness and fatigue of skeletal muscle.
- Ptosis fluctuation and oculomotor paresis.
- Muscle fatigue of levator muscle
- Results in binocular diploplia
- Often asymptomatic in morning, and feel effects during the day. **
HIV
Most common ocular finding are cotton wool spots. Infxns: - CMV retinitis - Toxoplasmosis Kaposi Sarcoma
AIDS Retinal Disease
- CMV retinitis is most common serious complication of AIDS.
- 25-40% have retinal detachment because of CMV
AIDS Retinal S/S
Floaters, decreased or blurred vision, scotoma, photopsia (flashing lights).
Toxoplasmosis Retinitis
Potentially blinding, necrotizing retinitis.
Toxoplasmosis S/S
- Wavy or distorted vision, floaters, pain, decreased or blurred vision.
- May see old scars, vitreous debris, yellow-white areas on retina, optic nerve yellow-white and swollen, macular edema.
Toxoplasmosis Tx
- Pyrethamine and folate
- Sulfisoxalone
- Clindamycen (triple therapy) + Pred
Diabetic Retinopathy is now the leading cause of ______ _______ in the US.
New blindness
Excess glucose bound with free amino acids forms?
Advanced glycosylation end products (AGE’s)
-These crosslink with collagen and initiate microvascular complications.
Vascular endothelial growth factor (VEGF)
Synthesized in the retina and can be excessively synthesized leading to the overgrowth of new blood vessels.
Diabetic Retinopathy Symptoms
- Some pt’s w/ severe disease can have 20/20 vision
- Blurring slowly OR suddenly.
- Visual distortion
- Floaters which can be from vitreous hemorrhage.
- Scotoma
Early Nonproliferative Retinopathy
Type of Diabetic Retinopathy
- Microaneurysms and intraretinal hemorrhages.
- Cotton wool spots
- Visual acuity is often unaffected
- Graded mild, mod, severe
Advanced Nonproliferative Retinopathy
Findings include cotton wool spots (CWS) and extensive retinal hemorrhages.
Which DM retinopathy is responsible for the most devastating vision loss?
Proliferative Retinopathy
Proliferative Retinopathy
- Characterized by Vitreous hemorrhage, tractional retinal detachment.
- Neovascularization (new vessels growing, may be on iris)
- This can lead to neovascular glaucoma
DM Retinopathy Tx
- *Well-managed diabetes (normal A1c)**
- Photocoagulation for macular edema
- Growth factor inhibitors
Photocoagulation for Proliferative Retinopathy
A laser is used to place 1000 - 2000 burns in evenly distributed pattern across entire retina except macula.
-This causes proliferating vessels to dissapear
All diabetics need a yearly _______ ______ _______.
Dilated Retinal Exam by an opthomologist
Acute Retinal Necrosis
Caused by herpes zoster in immunocompromised individuals
Symptoms: Decreased vision
Can cause blindness, refer these individuals
Sjogrens Syndrome
Syndrome of systemic autoimmune exocrinopathy
Inflammatory infiltration of lacrimal glands
- Leads to cell death
- Tear hypersecretion
- Keratoconjunctivitis Sicca (chromic dry eyes)
