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Ophthalmology > Ocular Manifestations of Systemic Disease > Flashcards

Ocular Manifestations of Systemic Disease Flashcards

1
Q

Traumatic Disorder

A
  • Shaken baby syndrome is increasingly evident in our society.
  • Fundoscopy may reveal preretinal, intraretinal or vitreous hemorrhages.
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2
Q

Hypertensive Retinopathy

A
  • Occurs in 15% of patients with just HTN.

- Rarely by itself causes significant vision loss.

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3
Q

Hypertensive changes in the eye (Mild)

A
  • Retinal artery narrowing
  • Arterial wall thickening or opacification
  • Arteriovenous nicking (nipping)
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4
Q

Hypertensive changes in the eye (Moderate)

A
  • Hemmorhages: flame or dot shaped
  • Cotton-wool spots
  • Hard exudates
  • Microaneurysms
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5
Q

Hypertensive changes in the eye (Severe)

A
  • Some or all of moderate
  • Optic disc edema
  • Presence of papilledema mandates lowering of the BP!
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6
Q

Focal narrowing, exudates and flame hemorrhages are related to _________ BP levels

A

Current

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7
Q

Copper wire

A

Arteriolar sclerotic changes with arteriolar narrowing.

A long-lasting HTN ocular effect.

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8
Q

Silver wire

A

With halogen light source, sclerosis of vessel is seen. Appears white.

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9
Q

HTN retinopathy S/S

A

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
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10
Q

HTN retinopathy treatment

A
  • Control HTN
  • Manage renal disease associated w/ HTN.
  • Refer to optho
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11
Q

Swelling of the optic disc

A
  • Hallmark of malignant HTN.
  • A sudden drop in perfusion can result in optic disc infarction and blindness.
  • BP must be controlled immediately.
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12
Q

Intracranial HTN

A
  • Most common ocular manifestation is optic disc swelling (papilledema)
  • Transient visual symptoms
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13
Q

Grave’s Opthalmopathy

A
  • Occurs in about 20% of patients w/ grave’s.
  • More common in women
  • Smoking is a risk factor
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14
Q

Grave’s O Patho

A

T lymphocytes cause inflammation and accumulation of hydrophilic glycosaminoglycans (GAG).

  • Restricts upward gaze
  • Results in vertical diploplia
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15
Q

Grave’s O S/S

A

Signs:

  • Proptosis (exopthalmus)
  • Preorbital Edema

VIsual Symptoms:
-Excessive tearing, eye pain, blurred vision, diploplia, occasional loss of vision

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16
Q

Grave’s O complications

A

Exopthalmus
Dry eyes, corneal ulceration
EOM impairment
-Diploplia, no upward vision, cannot achieve or maintain convergence.

17
Q

Tx of Grave’s O

A

Treat underlying Hypothyroidism
Mild:
-Dark glasses, artificial tears, elevate head, Oral selenium.

Severe:
-Glucocorticoids, Radiation or surgery.

18
Q

Ocular Myasthenia Gravis

A
  • 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. **
19
Q

HIV

A 
Most common ocular finding are cotton wool spots.
Infxns:
- CMV retinitis
- Toxoplasmosis
Kaposi Sarcoma
20
Q

AIDS Retinal Disease

A
  • CMV retinitis is most common serious complication of AIDS.

- 25-40% have retinal detachment because of CMV

21
Q

AIDS Retinal S/S

A

Floaters, decreased or blurred vision, scotoma, photopsia (flashing lights).

22
Q

Toxoplasmosis Retinitis

A

Potentially blinding, necrotizing retinitis.

23
Q

Toxoplasmosis S/S

A
  • 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.
24
Q

Toxoplasmosis Tx

A
  • Pyrethamine and folate
  • Sulfisoxalone
  • Clindamycen (triple therapy) + Pred
25
Q

Diabetic Retinopathy is now the leading cause of ______ _______ in the US.

A

New blindness

26
Q

Excess glucose bound with free amino acids forms?

A

Advanced glycosylation end products (AGE’s)

-These crosslink with collagen and initiate microvascular complications.

27
Q

Vascular endothelial growth factor (VEGF)

A

Synthesized in the retina and can be excessively synthesized leading to the overgrowth of new blood vessels.

28
Q

Diabetic Retinopathy Symptoms

A
  • 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
29
Q

Early Nonproliferative Retinopathy

A

Type of Diabetic Retinopathy

  • Microaneurysms and intraretinal hemorrhages.
  • Cotton wool spots
  • Visual acuity is often unaffected
  • Graded mild, mod, severe
30
Q

Advanced Nonproliferative Retinopathy

A

Findings include cotton wool spots (CWS) and extensive retinal hemorrhages.

31
Q

Which DM retinopathy is responsible for the most devastating vision loss?

A

Proliferative Retinopathy

32
Q

Proliferative Retinopathy

A
  • Characterized by Vitreous hemorrhage, tractional retinal detachment.
  • Neovascularization (new vessels growing, may be on iris)
  • This can lead to neovascular glaucoma
33
Q

DM Retinopathy Tx

A
  • *Well-managed diabetes (normal A1c)**
  • Photocoagulation for macular edema
  • Growth factor inhibitors
34
Q

Photocoagulation for Proliferative Retinopathy

A

A laser is used to place 1000 - 2000 burns in evenly distributed pattern across entire retina except macula.
-This causes proliferating vessels to dissapear

35
Q

All diabetics need a yearly _______ ______ _______.

A

Dilated Retinal Exam by an opthomologist

36
Q

Acute Retinal Necrosis

A

Caused by herpes zoster in immunocompromised individuals
Symptoms: Decreased vision
Can cause blindness, refer these individuals

37
Q

Sjogrens Syndrome

A

Syndrome of systemic autoimmune exocrinopathy
Inflammatory infiltration of lacrimal glands
- Leads to cell death
- Tear hypersecretion
- Keratoconjunctivitis Sicca (chromic dry eyes)

Ophthalmology (12 decks)

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