Ocular manifestations of systemic disease

Question 1

List three ocular manifestations in systemic disease

Answer 1

diabetes
cancer
hypertension
rheumatological conditions
neuro conditions
thyroid disease
genetic disorders

Question 2

List three effects of diabetes on the eye

Answer 2

Increased susceptibility to infection (e.g. cellulitis)
Dry eyes and keratitis
Anterior uveitis
Cataract
Diabetic papillitis
Diabetic retinopathy
Cranial nerve palsies

Question 3

List three features of diabetic retinopathy

Answer 3

Microaneurysms
Blot/ dot haemorrhages
Hard exudates
Cotton-wool spots
New vessels

Question 4

Which type of diabetic retinopathy can result in vitreous haemorrhage?

Answer 4

proliferative

Question 5

Discuss the mechanism by which proliferative retinopathy results in vitreous haemorrhage

Answer 5

Retinal ischaemia causes release of angiogenic growth factors such as VEGF

Stimulates development of new blood vessels to bypass damaged blood vessels – NEOVASCULARISATION

New vessels are fragile, leaky, and misdirected

Can result in vitreous haemorrhage or tractional retinal detachment

Question 6

What causes cotton wool spots in diabetic retinopathy?

Answer 6

damage to nerve fibres of the retina

Question 7

What is the composition of the macula?

Answer 7

high density of cones- high acuity vision

Question 8

Damage to the macula will result in which type of vision loss?

Answer 8

central vision loss

Question 9

What are the two categories of diabetic retinopathy?

Answer 9

non proliferative and proliferative

Question 10

Name a feature of proliferative diabetic retinopathy

Answer 10

neovasculrisation
vitreous haemorrhage

Question 11

Name a feature of diabetic maculopathy?

Answer 11

macular oedema
ischaemic maculopathy

Question 12

List two complications of diabetic retinopathy

Answer 12

Retinal detachment
Vitreous haemorrhage (bleeding in to the vitreous humour)
Rebeosis iridis (new blood vessel formation in the iris)
Optic neuropathy
Cataracts

Question 13

List two aspects of diabetic retinopathy management

Answer 13

Laser photocoagulation
Anti-VEGF medications such as ranibizumab and bevacizumab
Vitreoretinal surgery (keyhole surgery on the eye) may be required in severe disease
Good glycaemic control

Question 14

What causes hard exudates to form?

Answer 14

damaged vessels leaking lipids into the retina

Question 15

Silver/copper wiring is a feature of which ocular condition?

Answer 15

hypertensive retinopathy

where the walls of the arterioles become thickened and sclerosed causing increased reflection of the light

Question 16

List two features of hypertensive retinopathy

Answer 16

Cotton wool spots
Arteriovenous nipping
Retinal haemorrhages
Papilloedema
Hard exudates

Question 17

Name the classification for hypertensive retinopathy

Answer 17

Keith-Wagner classification

Question 18

What is a feature of stage 4 in the Keith-Wagener classification? (worst stage)

Answer 18

papilloedema

Question 19

Name three rheumatological conditions in which there are ocular manifestations

Answer 19

sjorgen’s syndrome
juvenile idiopathic arthritis
HLA-B27 disease
RA
Giant cell arteritis
GPA

Question 20

WHat is the ocular manifestation in sjorgen’s?

Answer 20

dry eyes

Question 21

What is the ocular manifestation in juvenile arthritis?

Answer 21

uveitis

Question 22

What is the ocular manifestation in HLAB27 disease?

Answer 22

anterior uveitis

Question 23

What is the ocular manifestation in RA?

Answer 23

scleritis

Question 24

What is the ocular manifestation in Giant cell arteritis?

Answer 24

ischaemic optic neuropathy
cranial nerve palsies

Question 25

Is anterior uveitis painful?

Answer 25

mildly painful, painful when looking at light due to inflammation of the iris

Question 26

Name two ocular features of raid intracranial pressure

Answer 26

swollen optic nerves enlarged blind spots

Question 27

List three ocular features of optic neuritis

Answer 27

Decreased vision Reduced colour vision (red desaturation) Pain on eye movement Enlarged blind spot RAPD nystagmus uveitis

Question 28

What is the treatment of scleritis?

Answer 28

oral steroids

Question 29

List three features of giant cell arteritis/temporal arteritis

Answer 29

Headache Scalp tenderness Jaw Claudication Polymyalgia Rheumatica Acute visual loss Ischaemic optic neuropathy Artery occlusions Cranial nerve palsy

Question 30

List two features of thyroid eye disease

Answer 30

Swelling of lids Chemosis (oedema) of conjunctiva Exposure of cornea (loss of blink, lid retraction) Pronounced exophthalmos / proptosis Restricted eye movements Optic Neuropathy

Question 31

Name two investigations for papilloedema

Answer 31

CT Lumbar puncture venogram?

Question 32

What must you note in LP for assessing papilloedema

Answer 32

opening pressure- cmH20

Question 33

Name a connective tissue disorder that results in ocular manifestations

Answer 33

Marfan's syndrome

Question 34

Name one ocular feature of Marfan's syndrome

Answer 34

Retinal detachment Disclocated lens