Ocular Manifestations of Systemic Disease- Exam 3 Flashcards by Johannah Crumpton

_____ damage specifically to the retina from prolonged HTN

hypertensive retinopathy

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______ Due to inadequate perfusion of posterior ciliary arteries supplying the anterior portion of the optic nerve causing ______

Anterior ischemic optic neuropathy

optic disk swelling

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What is the cause of retinal vein and artery occlusion?

increase pressure damaging the ocular blood vessels leading to emboli

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What is the clincial pearl associated with retinal vein occlusion?

“blood and thunder fundus” due to widespread retinal hemorrhages and venous dilation and tortuosity

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Central retinal artery occlusion you are likely to see ____ and _____ associated with HTN

cherry red spot on fovea and boxcar segmentation

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When comparing arteries and vein in the eye, which one is lighter?

arteries are lighter in color than veins. veins are darker

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_____ are small, yellow-white, slightly elevated lesions, which look like clouds on retinal surface

Cotton Wool Spots AKA “Soft Exudates”

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A small artery is seen crossing a small vein
This causes compression on the small vein
Indentation (nicking) of retinal veins by stiff (arteriosclerotic retinal arteries) is ____. What dz is it associated with?

A-V nicking

HTN

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What are copper and silver wiring due to ? commonly seen in what dz? Which one is worse?

Both due to atherosclerotic vessel wall thickening

chronic HTN

Copper: Moderate vascular wall changes
Appear orange or yellow instead of red

Silver: Severe vascular wall hyperplasia and thickening
Appear white

Silver is worse

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____ are caused by alters the retina’s microvasculature, causing leakage from arterioles and veins. Appear in the retina’s superficial layers. What dz?

Flame Hemorrhages

HTN

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HTN increases your risk of what 4 ocular conditions?

-Overall vision loss
- age-related macular degeneration
- open angle glaucoma
- subconjunctival hemorrhage

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Age-related macular degeneration is due to ????

Due to decreased blood flow to the retina leading to neovascularization

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How does DM affect the eye?

sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well

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blurry vision/loss of sharp vision, vision loss, floaters, decreased color perception

How does a pt with DM vision changes present?

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What are the stages of Diabetic Retinopathy?

Stage 1-4.

1 is mild and 4 is severe

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______ is the leading cause of new cases of blindness in people aged 20–74 in the United States

Diabetic retinopathy (DR)

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Diabetes doubles the chances of developing ____ and ______

glaucoma and cataracts

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Name some fundoscopic findings that are common in pts with DM?

**Flame hemorrhage
Hard exudates
**Cotton wool spots
Neovascularization
Microaneurysms
Macular Edema
Dot Blot Hemorrhages

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Neovascularization is commonly seen in _____ and ______

diabetic retinopathy and macular degeneration

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What is neovascularization caused by?

Microvascular damage and ischemia cause release of vasoproliferative factors (Vascular Endothelial growth Factor)
This results in new vessel from the adjacent retinal vessels in an attempt to revascularize the diseased tissue

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How can you tell the difference between soft and hard exudates?

Soft: exudates are small, light yellowish-white or grayish-white slightly higher lesions which appears as clouds on retina and their edges are blurry and not clearly defined

hard: exudates are small white or yellowish white deposits and their edges are clear and sharp

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_____ Occur as microaneurysms rupture in the deeper layers of the retina.
Blood accumulates in the ____

Dot-Blot Hemorrhages

Inner nuclear layer

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_____ a blue ring around the rim of the iris, is due to cholesterol deposits in the eye, seen more frequently with aging and ______

Arcus senilis

chronic hyperlipidemia

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______ a yellowish patch on the skin surrounding the eyelid, is caused by buildup of _____ under the skin.

Xanthelasma

cholesterol

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Central retinal artery occlusion is classicaly characterized by ____ and _____

boxcar segmentation and cherry red spot on fovea

Ischemic optic neuropathy is due to ???? and ????

due to decreased blood flow to artery supplying anterior portion of optic nerve and Swelling of optic disk

What are two classic signs of macular degernation? what kind does each represent?

neovascularization (wet) and retinal drusen (dry)

In terms of the eye, what is Grave's disease characterized by? Which can be seen on exam as _____. What are some additional signs of Grave's disease?

inflammation around the eyes, connective tissue and extraocular muscles exophthalmos **keratoconjunctivitis sicca, blurred vision, and discomfort for the patient.

______ dry eye result of decreased aqueous tear production. Secondary to lacrimal gland inflammation

keratoconjunctivitis sicca

Gritty, dry sensation in eyes, photophobia, double vision, excessive tearing, pressure behind the eye, edema of periorbital tissues, inflammation of conjunctiva are all associated with _____

Thyroid Disease - Graves Disease

There have been studies linking increased risk of _____ risk in Grave’s Disease Patients

open angle glaucoma

Due to _____ behind and alongside the eyeballs caused by Graves' disease causing _____ inside the eyes, and increasing pressure inside the ____ around the eyes

swelling of tissues increase pressure veins

Sarcoidosis is a disease most commonly affects the ??? but can affect virtually any organ. What pt population is in MC in?

skin, lungs, lymph nodes, and eyes Nordic and African American populations

Sarcoidosis with common ocular involvements include ____ and ______

uveitis conjunctival nodules

In sarcoidosis, what is the most common ocular manifestation? ______ classified as anterior, posterior or intermediate - vitreous opacities and keratic precipitates, hypopyon if severe

uveitis Granulomatous uveitis

“INFLAMMATORY CELLS AND FLARE” (proteins) WITHIN THE AQUEOUS on slit lamp exam is classic for _____

Granulomatous uveitis

_____ dry eye result of decreased aqueous tear production secondary to lacrimal gland inflammation Blurry vision, photophobia, pain

Keratoconjunctivitis sicca

Keratoconjunctivitis sicca can also effect ____ and the _____ and can present with palpable masses, eyelid swelling, ptosis, proptosis and pain

extraocular muscles orbital fat optic nerve sheath

Neuro-ophthalmic manifestations are most common cranial neuropathy in the ____ and _____ nerves

facial and optic nerves

Neurosarcoidosis can manifest as ____, _____, and _____

papilledema, nystagmus and visual field defects

______ Autoimmune disorder of skeletal muscles characterized by fluctuating weakness. This can result in ____

Myasthenia gravis limited EOM

_____ pattern of ptosis switching from eye to eye. Commonly seen in ____

Alternating unilateral ptosis Myasthenia gravis

_____ double vision is only present when both eyes are open. Commonly seen in what dz?

Binocular diplopia Myasthenia gravis

_____ is the misalignment of the eyes. What are the types?

Strabismus Esotropia: inward turning Exotropia: outward turning Hypotropia: downward turning Hypertropia: upward turning

_____ have pt look down followed up upward gaze causing eye to twitch. What dz is it associated with?

Cogan lid twitch Myasthenia Gravis

_____ are associated with Rheumatoid disorders. What is another name for them?

Giant Cell Arteritis Temporal Arteritis

____ is the most important medical emergency in ophthalmology. What are the s/s? Who is the MC population? What is it caused by?

Giant Cell Arteritis New onset temporal or occipital headache Decreased visual acuity is possible Jaw pain (Scalp tenderness) people older than 50 years old caused by inflammation in the arteries

Giant cell arteritis is closely linked with _____

polymyalgia rheumatica

What is the most feared complication of giant cell arteritis? secondary to ???

permanent visual loss arteritic anterior ischemic optic neuropathy

_____ commonly painless and sudden vision loss, may be partial or complete, and may be unilateral or bilateral. Is it preventable?

arteritic anterior ischemic optic neuropathy blindness in GCA is preventable if these patients are diagnosed early and treated immediately and aggressively.

Ischemic optic neuropathy in giant cell arteritis can lead to ____ and _____

Optic disk edema and RAPD

What is RAPD? What is the test called?

normal consensual response, no direct response; if an optic nerve lesion is present, the affected pupil will not constrict to light when light is shone in that pupil. It will constrict, however, when light shone into other eye Swinging eye flashlight test

Giant cell arteritis is characterized by ____, ____ and ____. The optic disc will look like ???

bilateral disc edema, HA and scalp tenderness no clear shape

Unilateral optic neuritis Painless diplopia RAPD Nystagmus Optic disk swelling

How do the ocular symptoms of multiple sclerosis present?

____ manifesting with painful, monocular visual loss consisting of visual blurring or scotoma (blind spot). What dz is it associated with?

Unilateral optic neuritis Multiple sclerosis

_____ accumulation of white cells in mid section of eye due to inflammation causing damage to lens, iris, and retina. What dz is it associated with?

Pars planitis Multiple Sclerosis

Ocular manifestations are some of the first signs that a HIV/AIDS disease has progressed and perhaps is indicative that ______

an opportunistic infection is present

HIV retinopathy is characterized by what 3 things?

Cotton-wool spots Retinal hemorrhages Microaneurysms

______ full thickness retinal infection that can lead to necrosis and retinal breaks and detachments. What are the s/s? What are the fundoscopic findings?

CMV Retinitis Floaters, blurred vision, visual field defects, and potentially rapid vision loss. areas of necrosis and hemorrhage.

_____ A secondary disease that can be caused by HIV/AIDS, and this can manifest in the eye which could result in vision loss. What are some s/s?

Herpes keratoconjunctivitis and Herpes zoster ophthalmicus Redness, pain, and decreased vision. Usually abrupt onset, initially noticing a gritty sensation in eye, followed by redness and tearing

What is the slam dunk finding for Herpes keratoconjunctivitis?

Slit-lamp examination reveals a corneal ulcer with characteristic **dendritic lesions**

_____ involvement of the tip of the nose = a clinical predictor of ocular involvement

Hutchinson's sign

_____ dome shaped papules on eyelid

Molluscum contagiosum

“cells and flare” on slit lamp exam is slam dunk characteristic of ____

Anterior uveitis

Red hemorrhagic lesions associated with conjunctival manifestation is consistent with _____

Kaposi Sarcoma

What are conjunctival lymphomas? Associated with ???

patchy salmon colored raised appearance HIV

_____ dry eye - seen in roughy 20% of HIV pts

Keratoconjunctivitis sicca