Ocular Manifestations of Systemic Disease

Question 1

Hypertensive Retinopathy Mild

Answer 1

Retinal artery narrowing (Due to vasospasm)
Arterial wall thickening or opacification
Arteriovenous nicking

Question 2

Hypertensive Retinopathy Moderate

Answer 2

Hemorrhages—either flame or dot shaped
Cotton-wool spots
Hard exudates (lipid residue from serous leakage from damaged capillaries)
Microaneurysms

Question 3

Hypertensive Retinopathy Severe

Answer 3

Hemorrhages—either flame or dot shaped
Cotton-wool spots
Hard exudates (lipid residue from serous leakage from damaged capillaries)
Microaneurysms
NEW:
Presence of papilledema MANDATES lowering of the BP!!

Question 4

Long standing hypertension can produce

Answer 4

arteriolar sclerotic changes, w/ arteriolar narrowing (copper wire)

AV nicking

With halogen light source see sclerosis of vessel, white retinal vessel (silver wire)

Question 5

Early hypertensive retinal changes

Answer 5

flame shaped hemorrhages

Question 6

What is the hallmark sign of HTN?

Answer 6

Swelling of the optic disc

Patient w/ malignant HTN is at risk of developing heart and renal failure, stroke, and hypertensive encephalopathy

Question 7

papilledema

Answer 7

optic disc swelling (Most common ocular manifestation of intracranial HTN)

Question 8

common causes of intracranial hypertension

Answer 8

brain tumor
venous sinus thrombosis
Meningitis
Hydrocephalus
pseudotumor cerebri
Tetracycline therapy
Steroid withdrawal

Question 9

Pathogenesis of Grave’s

Answer 9

activation of T lymphocytes result in inflammation and the accumulation of hydrophilic glycosaminoglycans (GAG)*
Affects inferior rectus muscle (can’t gaze upwards)

Question 10

Myathesnia Gravis

Answer 10

Autoimmune disorder characterized by weakness and fatigue of skeletal muscles

Due to dysfunction at the neuromuscular junction:
AChR-Ab (acetyl choline receptor-antibodies)

Ptosis fluctuation & oculomotor paresis:
Fatigability of the levator muscle
Ophthalmoparesis results in binocular diplopia

Question 11

HIV

Answer 11

Most common finding cotton wool spots

Infections:
CMV retinitis
Toxoplasmosis

Question 12

CMV sx.

Answer 12

Sx: floaters, decreased or blurred vision, scotoma, photopsia (“flashing lights”), NEW visual Sx require dilated fundoscopic exam

CMV retinitis most common serious ocular complication of AIDS
25-40% have retinal detachment because of CMV

Question 13

Toxoplasmosis S/S

Answer 13

Sx: wavy or distorted vision (metamorphopsia), floaters, pain-variable, decreased or blurred vision

Signs: may see old scars, vitreous debris, yellow-white areas on retina, optic nerve yellow-white & swollen, macular edema

Question 14

What is the leading cause of blindness in the US?

Answer 14

Diabetic retinopathy is now the leading cause of new blindness in adults in the United States!