Ocular Manifestations of Systemic Disease Lecture Powerpoint Flashcards
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Ocular manifestations of down syndrome
Appear with mongolian type face along with eye problems such as strabismus (eye wandering) as well as crossed eyes and early glaucoma - go on to eventually have heart and other problems as well
Ocular manifestations of marfan syndrome
Lens inside eyes have weakened fibrils that can cause the lens to slip out of place resulting in sudden blurry or distorted vision onset
Ocular manifestations of tubular sclerosis
Causes benign tumor growth all over body including CNS (brain spinal cord and eyes)
Ocular manifestations of neurofibromatosis
Characterized by benign growths on all nervous tissue that can occur on the iris appearing as little nodules, glioma (glia matter surrounds central nerves) of the optic nerve can cause vision loss
Characteristic finding of neurofibromatosis
6 or more hyperpigmented skin macules (cafe au lait spots)
The eyes are surrounded by ___ and as a result to not ____ when cut
meninges/glia matter, regenerate
What two nerves are actually part of the CNS?
Optic nerve (CN II) Olfactory nerve (CN I)
Shaken baby syndrome ocular manifestations
Due to fragile blood vessels in retina not being capable of undergoing trauma causing hemorrhages, can also be seen in adults with extreme trauma such as from car crash
Hypertension ocular manifestations
-Flamed shaped hemorrhages and cotton wool spots (high bp causes capillaries to leak preventing perfusion and causing infarct resulting in yellowish or white spots that take a while to repair
Optic artery and vein on fundoscopic
Artery is smaller and vein is larger and darker, all have 4 branches to the top and bottom and nasal and temporal off of that
Normal optic disk size
1.5 mm
AV nicking
Spots on fundoscopic exam where arteries and veins cross that in the case of high blood pressure causes constriction creating a visible gap in venous flow
Fovea centralis
Dark spot on the fundoscopic exam that is the primary spot of focus where all the cones of the eye are located within the macula densa
Malignant hypertension
Uncontrolled hypertension resenting with papilledema (swelling of the optic disk) demonstrating them at high risk for developing heart failure or other diseases, treatment requires immediate but controlled blood pressure control so not to infarct the tissue
Copper/silver wiring
Demonstrated on the fundoscopic exam where in cases of severe atherosclerosis patients vessels will appear brown or silver instead of red indicating severe progression of atherosclerosis
Intracranial hypertension ocular manifestation
Occurs when high pressure in aqueous humor builds causing blurring of the vision that lasts shortly or prolonged periods of times, visible on fundoscopic exam with optic disc swelling (papilledema)
Common causes of intracranial hypertension and how to assess for the first 2 (4)
- brain tumor (CT scan)
- meningitis (spinal tap)
- hydrocephalus
- pseudomotor cerebri
Pseudomotor cerebri occurs in what population?
Obese young women, associated with vitamin toxicity or drug rxn
Embolic disease
Sudden persistent visual loss that causes a pale retina in all areas except the retina which is cherry red upon fundoscopic examination, retina dies within 50 min of obstructed flow that can occur even in healthy patients
Hollenhorst plaque
Cholesterol embolus that lodges in the arterial bifurcation that doesn’t block the entire artery but may spontaneously resolve, if left untreated may not cause any issue immediately but can eventually lead to blindness or sequellae with stroke from larger embolus dislodging, treated with prednisone
Central retinal vein occlusion
Another cause of painless vision loss that is often associated with open angle glaucoma or systemic hypertension, ophthalmic exam reveals retinal hemorrhages and cotton wool spots
Migraine mech of action
- do not have to occur with headaches (anacephalic)
- 3x more common in females
- causes pounding because normal tone in blood vessels is increased resulting in less blood perfusion (causing visual disturbances and nausea) that eventually causes them to go flaccid
- these vessels are then distended and stretched causing pain sensation from stretch receptors
- eye blood vessels have no pain recepors
- usually one sided
- usually want quiet dark place to be left alone unlike tension headaches
Migraines are most common in ____ (men or women) and at what age groups?
women, puberty or menopause
Blood dyscrasias and 4 examples
Any abnormal or pathologic condition of the blood flow that can manifest with ocular symptoms such as amaurosis fugax
examples include hyperviscosity syndromes such as polycythemia vera, multiple myeloma, dysproteinemia, and leukemia
Neoplastic disorders ocular manifestations
- Metastatic carcinomas most often from breast or lung in women and prostate or lung in men can result in malignancy
- because of rich vasculature, choroid is common location causing apeparance of creamy white lesions
Autoimmune disorders ocular manifestations
- Tearing deficiency (dry eyes)
- foreign body sensation
- photophobia
Autoimmune disorder ocular manifestations treatments (2)
- artificial tears
- topical cyclosporin in some cases
Juvenile rheumatoid arthritis has….
….ocular involvement in the form of iritis, cateract, retinal bulging (2 iris appearance looking like an ectopic pupil) and BAND keratohathy (deposits of calcium in cornea)
SLE ocular manifestations
Many similar manifestations of dry eye to rheumatoid arthirits but most common severe involves vasculature (see hemorrhages despite adequate perfusion and no atherosclerosis)
Giant cell arteritis (symptoms (3), definition, diagnosis (2) and treatment (1))
Ocular emergency systemic vasculitis that affects people over age of 60 resulting in symptoms such as scalp or hair pain, difficulty chewing, and acute visual loss, ischemic optic neuropathy causing unilateral loss of vision is very common, diagnosed via C reactive protein (not necessarily sed rate in case patient is on nsaids), treated with corticosteroids
Giant cell arteritis will eventually affect…
…both eyes
Graves disease distribution
- 1/3 see impact only on orbit muscles and fat
- 1/3 see impact only thyroid surrounding tissue
- 1/3 see impact of both
Normal thyroid tests do not discount…
….thyroid disease
Most common extraocular muscle affected by thyroid disorder
Inferior rectus interfering with up gaze
Myasthenia gravis ocular manifestations and treatment
- Autoimmune dz at any age that blocks Ach receptors with antibodies causing weakness and droopy eyelid (often relieved with ice pack application)
- botox injection
Sarcoidosis ocular manifestations
Granulomatous uveitis
Multiple sclerosis ocular manifestations, symptoms, diagnosis
Seen in 40% of women aged 20-40, optic neuritis with acute, painful vision loss in one or both eyes occurring over a few days to 2 weeks, may be initial episode that eventually manifests with MS in 5 years, presents with visual pain with upward eye movement despite optic nerve looking normal and red desaturation on visual assessment
-CT scan of white matter lesion
3 most common classic lesions seen with AIDS occular manifestations
- cotton wool spots
- cytomegalovirus retinitis
- kapoi’s sarcoma
Diabetes mech of killing
- Causes chronic lack of blood flow due to leaking precapillary resulting in slow death of organs due to hypoperfusion
- organs that require constant perfusion (eyes, hearts, kidneys) will preserved as long as possible so extremities will go into failure very early on (vision loss is a late symptom of DM)
Pericytes
Cells embedded in capillary basement membrane that die early on in DM causing loss of endothelial cells resulting in microaneurysms
Types of diabetic retinopathy
- early proliferative (visual fields unaffected)
- advanced nonproliferative (ischemia and infarct of retina)
- proliferative (most devastating visual loss, neovascularization that may grow on surface of iris and block aqueous outflow causing neovascular glaucoma)
Photocoagulation for proliferative diabetic retinopathy
Laser burns used to evenly distribute scatter pattern across entire retina except macula causing proliferating vessels to disappear
Future drugs to prevent proliferative diabetic retinopathy (3)
-Avastin
-leucentis
-eylea
(all vascular endothelial growth factor inhibitors)
Drugs that have toxic ocular effects resulting in retinopathy (5)
- thiorodazine
- chloroquine
- tamoxifen
- ethambutol
- fluorquinolones
