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Opthamology > Ocular manifestations of Systemic Disease > Flashcards

Ocular manifestations of Systemic Disease Flashcards

1
Q

Hypertensive Retinopathy

  • mild changes
  • moderate
  • severe
A

Mild

  • retinal artery narrowing
  • arterial wall thickening or opacification
  • arteriovenous nicking- “nipping” (vein and artery cross, pressure in artery causes vein to bulge out & cause damage)

Moderate:

  • hemorrhage (flame or dot shaped)
  • cotton-wool spots (retinal nerve fiber layer microinfarction)
  • hard exudates (lipid residue from serous leakage from damaged capillaries)
  • microaneurysms

Severe:

  • some or all of the above
  • plus optic disc edema
  • presence of papilledema MANDATES lowering of BP.
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2
Q

What are silver and copper wire and when do they occur?

A

they occur with long standing hypertension:
*only occur in HTN Retinopathy (?)

Copper wire= arteriolar sclerotic (hard from constant pressure) changes w/
arteriolar narrowing. Moderate vascular wall changes.

Silver Wire=with halogen light source see sclerosis of vessel, white retinal vessel. More severe vascular hyperplasia and thickening.

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3
Q

Signs and symptoms of HTN Retinopathy

A

Sx: vision normal, blurred or sudden decreas; scotoma(waves in the air, spotty visual changes, usually unilateral and transient), diplopia

Signs:

  • arteriolar narrowing in chronic HTN
  • focal spasm in acute HTN
  • retinal edema
  • microaneurysm may rupture producing sudden vision loss from hemorrhage
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4
Q

Tx of HTN Retinopathy

A

CONTROL HTN, may be able to reverse some effects of HTN retinopathy

-refer to ophthalmologist

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5
Q

When looking at retina, what are the white and red punctate dots?

What are cotton wool spots caused from? How about yellow spots?

A

white= ischemia
red-hemorrhage

caused from ischemia

yellow spots are exudate- lipid residues of serous leakage from damaged capillaries

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6
Q

What are ghost vessels?

A

-new blood vessels formed to increase o2 and nutrient transport to retina, the old vessels become white b/c they are no longer being used.

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7
Q

What is the hallmark sign of malignant HTN?

What disease are these pts most likely to develop secondarily?

A

swelling of the optic disc- PAPILLEDEMA

-heart and renal failure, stroke, hypertensive encephalopathy

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8
Q

Why must BP be carefully controlled & reduced in malignant HTN pts?

A

BP must be controlled carefully immediately;

-a sudden drop in tissue perfusion can result in infraction of the optic disc (acute ischemic optic neuropathy) and subsequent blindness.

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9
Q

What is the most common ocular manifestation of intracranial HTN?

What are some the signs associated with this?

A

optic disc swelling- papilledema

-signs are transient; can range from mild blurring to complete visual loss usually lasting a few seconds. Fundoscopic exam reveals marked disc swilling and vascular engorgement.

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10
Q

Common causes of Intracranial HTN

A
  • brain tumor
  • venous sinus thrombosis
  • meningitis
  • hydrocephalus
  • pseudotumor cerebri
  • tetracycline therapy (not common)
  • steroid withdrawal
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11
Q

Pathogenesis of Diabtic Retinopathy

A
  • over time sugar causes damage to blood vessels. body wants to heal by increasing Vascular Endothelial Growth Factor (VEGF) leading to neovascularization.
  • this is key in Diabetic Retinopathy (DR) (?)p
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12
Q

Sx of DR

A
  • blurring suddenly or slowly
  • visual distortion (crooked/wavy)
  • floaters from vitreous hemorrhage (shower)
  • scotoma
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13
Q

How often is eye exam performed in diabetic patients?

A

EVERY. SINGLE. YEAR.

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14
Q

Types of Diabetic Retinopathy & signs associated with each.

A

Early Nonproliferative:

  • microaneruysm and intraretinal hemorrhages
  • cotton wool spots
  • visual acuity is usually unaffected
  • graded: mild, moderate, severe
  • sounds like HTN
  • Advanced Nonproliferative:
  • cotton wool spots
  • extensive retinal hemorrhages

Proliferative:

  • vitreous hemorrhage and tractional retinal detachment
  • NEOVASCULARIZATION; not always confined to the retina
  • new vessels may grown on the surface of the iris and the trabecular meshwork, blocking aqueous outflow causing a very dangerous form of GLAUCOMA.
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15
Q

Tx of DR

A
  • photocoagulation (Laser) for macular edema (ophthomologist does this)
  • leaking vessels are treated directly with the laser to seal them and prevent further vision loss, not to improve visual acuity.
  • Intraocular injection of Growth Factor inhibitors.

-Treat Blood sugar as you can and refer to Ophtho.

surgery:

  • used to remove nonclearing vitreous hemorrhage and to treat/prevent retinal detachment
  • vitreous removed and destroy new retinal vessels. O
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16
Q

Graves Ophthalmopathy Pathogensis

-what muscles are most commonly affected?

A
  • activation of T lymphocytes result in inflamm and infiltration of orbital connective tissue. Inflamm results in a deposition of collogen and glycoaminoglycans in the muscles, leading to enlargement and fibrosis of eye muscles.
  • most commonly affected muscles: inferior rectus
17
Q

Signs & Symptoms of Graves Ophtho.

A

Signs

  • proptosis (bug eyes)
  • periorbital edema

Visual symptoms

  • excessive tearing, conjunctivitis, eye or retroorbital pain
  • blurred vision, diplopia (usually vertical), occasional loss of vision.
18
Q

Physical Exam pts w/ Graves Ophtho.

A
  • see lid lage and stare
  • determine extent to which upper/lower lids close.
  • assess EOM range of motion
  • evaluate visual acuity, color vision, and visual fields.
19
Q

Complications of Graves

A
  • proptosis: dry eyes & corneal ulceration
  • extraocular muscle impairment: diplopia (side by side image), inability to achieve upward vision or to maintain convergence.
20
Q

Tx of Graves Ophtho.

A

-treat underlying hyperthyroidism - surgery or meds

Mild symptoms:

  • dark glasses
  • artificial tears
  • raise head of bed

Severe:

  • glucocorticosteroids - IV or oral (only thing that treats severe exopthalmos)
  • if vision threatened–radiation then surgery.
21
Q

Ocular Myasthenia Gravis Pathogensis

A
  • autoimmune disorder characterized by weakness and fatigue of skeletal muscles (works head down, eyes usually first affected)
  • due to dysfunction of NMJ (Ach related)
  • ptosis d/t levator palpebrae superioris
  • binocular diplopia d/t opthalmoparesis (weakeness of the extraocular muscles)
22
Q

Tx of Myasthenia Gravis

A
  • smyptomatic- anticholinesterase meds (increase Ach)
  • chronic immunomodulatiing
  • rapid immunomodulating
  • surgical (remove thymus)
23
Q

What is the most common ophtho. finding in HIV patients?

A

Cotton wool spots

24
Q

What is the most common serious complication of AIDS? Describe this disease.

A

CMV retinitis- Cytomegalovirus retinitis

-it is from the Herpes family

25
Q

Symptoms of CMV retinitis

A

25-40% have retinal detachment

  • usually unilateral but move to both eyes if not treated
  • floaters, decreased or blurred vision, scotoma, photopsia (flashing lights)
  • *frosted branch appearance is classic of CMV

***New visual symptoms in an HIV patient require a dilated fundoscope exam by ophtho.

26
Q

CMV retinitis treatment

A
  • anti-HIV meds
  • IV or intravitrial antivirals
  • implants of drug
27
Q

What is Toxoplasmosis Retinitis?

A

Potentially blinding, necrotizing retinitis caused by parasite, carried by a cat. Most people can fight off but immunosuppressed ppl cannot.

28
Q

Toxoplasmosis Retinitis signs and symptoms

A

-symptoms: 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 and swollen, macular edema. Headlight in the fog (where infection is) blurry white spot =infection of vitreous. O

29
Q

Toxoplasmosis Retinitis treatment

A

pyrimethamone, sulfadiazine with folate, corticosteroids

*an infectious disease specialist will treat this, not us.

30
Q

Herpes Zoster Infection

  • who gets this?
  • Sx
  • Dx
A
  • rare to involve retina unless immunocompromised such as HIV/AIDS or pregnant
  • Symptoms: develop acute retinal necrosis from varicella zoster virus, decreased vision

Dx- immediate fundoscopic exam and refer to ophtho.

31
Q

Traumatic Disorder: Shaken baby syndrome

A
  • see dark hemorrhage on retina/vitreous
32
Q

Further rheumatological differential of Ocular Disease

A
  • Sjogrens syndrome
  • Systemic Lupus Erythematosus
  • Inflammatory bowel disaes
  • Sarcoidosis ( granulomas= collection of inflamm cells)

Opthamology (8 decks)

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