Ocular Manifestations of Systemic Disease- Exam 3 Flashcards
_____ damage specifically to the retina from prolonged HTN
hypertensive retinopathy
______ Due to inadequate perfusion of posterior ciliary arteries supplying the anterior portion of the optic nerve causing ______
Anterior ischemic optic neuropathy
optic disk swelling
What is the cause of retinal vein and artery occlusion?
increase pressure damaging the ocular blood vessels leading to emboli
What is the clincial pearl associated with retinal vein occlusion?
“blood and thunder fundus” due to widespread retinal hemorrhages and venous dilation and tortuosity
Central retinal artery occlusion you are likely to see ____ and _____ associated with HTN
cherry red spot on fovea and boxcar segmentation
When comparing arteries and vein in the eye, which one is lighter?
arteries are lighter in color than veins. veins are darker
_____ are small, yellow-white, slightly elevated lesions, which look like clouds on retinal surface
Cotton Wool Spots AKA “Soft Exudates”
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
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
____ 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
HTN increases your risk of what 4 ocular conditions?
-Overall vision loss
- age-related macular degeneration
- open angle glaucoma
- subconjunctival hemorrhage
Age-related macular degeneration is due to ????
Due to decreased blood flow to the retina leading to neovascularization
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
blurry vision/loss of sharp vision, vision loss, floaters, decreased color perception
blurry vision/loss of sharp vision, vision loss, floaters, decreased color perception
How does a pt with DM vision changes present?
What are the stages of Diabetic Retinopathy?
Stage 1-4.
1 is mild and 4 is severe
______ is the leading cause of new cases of blindness in people aged 20–74 in the United States
Diabetic retinopathy (DR)
Diabetes doubles the chances of developing ____ and ______
glaucoma and cataracts
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
Neovascularization is commonly seen in _____ and ______
diabetic retinopathy and macular degeneration
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
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
vs
hard: exudates are small white or yellowish white deposits and their edges are clear and sharp
_____ Occur as microaneurysms rupture in the deeper layers of the retina.
Blood accumulates in the ____
Dot-Blot Hemorrhages
Inner nuclear layer
_____ 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
______ a yellowish patch on the skin surrounding the eyelid, is caused by buildup of _____ under the skin.
Xanthelasma
cholesterol
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
