Ocular Manifestations of Systemic Disease Lecture Powerpoint

Question 1

Ocular manifestations of down syndrome

Answer 1

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

Question 2

Ocular manifestations of marfan syndrome

Answer 2

Lens inside eyes have weakened fibrils that can cause the lens to slip out of place resulting in sudden blurry or distorted vision onset

Question 3

Ocular manifestations of tubular sclerosis

Answer 3

Causes benign tumor growth all over body including CNS (brain spinal cord and eyes)

Question 4

Ocular manifestations of neurofibromatosis

Answer 4

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

Question 5

Characteristic finding of neurofibromatosis

Answer 5

6 or more hyperpigmented skin macules (cafe au lait spots)

Question 6

The eyes are surrounded by ___ and as a result to not ____ when cut

Answer 6

meninges/glia matter, regenerate

Question 7

What two nerves are actually part of the CNS?

Answer 7

Optic nerve (CN II)
Olfactory nerve (CN I)

Question 8

Shaken baby syndrome ocular manifestations

Answer 8

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

Question 9

Hypertension ocular manifestations

Answer 9

-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

Question 10

Optic artery and vein on fundoscopic

Answer 10

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

Question 11

Normal optic disk size

Answer 11

1.5 mm

Question 12

AV nicking

Answer 12

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

Question 13

Fovea centralis

Answer 13

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

Question 14

Malignant hypertension

Answer 14

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

Question 15

Copper/silver wiring

Answer 15

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

Question 16

Intracranial hypertension ocular manifestation

Answer 16

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)

Question 17

Common causes of intracranial hypertension and how to assess for the first 2 (4)

Answer 17

• brain tumor (CT scan)
• meningitis (spinal tap)
• hydrocephalus
• pseudomotor cerebri

Question 18

Pseudomotor cerebri occurs in what population?

Answer 18

Obese young women, associated with vitamin toxicity or drug rxn

Question 19

Embolic disease

Answer 19

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

Question 20

Hollenhorst plaque

Answer 20

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

Question 21

Central retinal vein occlusion

Answer 21

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

Question 22

Migraine mech of action

Answer 22

• 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

Question 23

Migraines are most common in ____ (men or women) and at what age groups?

Answer 23

women, puberty or menopause

Question 24

Blood dyscrasias and 4 examples

Answer 24

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

Question 25

Neoplastic disorders ocular manifestations

Answer 25

• 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

Question 26

Autoimmune disorders ocular manifestations

Answer 26

• Tearing deficiency (dry eyes)
• foreign body sensation
• photophobia

Question 27

Autoimmune disorder ocular manifestations treatments (2)

Answer 27

• artificial tears

- topical cyclosporin in some cases

Question 28

Juvenile rheumatoid arthritis has….

Answer 28

….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)

Question 29

SLE ocular manifestations

Answer 29

Many similar manifestations of dry eye to rheumatoid arthirits but most common severe involves vasculature (see hemorrhages despite adequate perfusion and no atherosclerosis)

Question 30

Giant cell arteritis (symptoms (3), definition, diagnosis (2) and treatment (1))

Answer 30

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

Question 31

Giant cell arteritis will eventually affect…

Answer 31

…both eyes

Question 32

Graves disease distribution

Answer 32

• 1/3 see impact only on orbit muscles and fat
• 1/3 see impact only thyroid surrounding tissue
• 1/3 see impact of both

Question 33

Normal thyroid tests do not discount…

Answer 33

….thyroid disease

Question 34

Most common extraocular muscle affected by thyroid disorder

Answer 34

Inferior rectus interfering with up gaze

Question 35

Myasthenia gravis ocular manifestations and treatment

Answer 35

• Autoimmune dz at any age that blocks Ach receptors with antibodies causing weakness and droopy eyelid (often relieved with ice pack application)
• botox injection

Question 36

Sarcoidosis ocular manifestations

Answer 36

Granulomatous uveitis

Question 37

Multiple sclerosis ocular manifestations, symptoms, diagnosis

Answer 37

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

Question 38

3 most common classic lesions seen with AIDS occular manifestations

Answer 38

• cotton wool spots
• cytomegalovirus retinitis
• kapoi’s sarcoma

Question 39

Diabetes mech of killing

Answer 39

• 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)

Question 40

Pericytes

Answer 40

Cells embedded in capillary basement membrane that die early on in DM causing loss of endothelial cells resulting in microaneurysms

Question 41

Types of diabetic retinopathy

Answer 41

• 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)

Question 42

Photocoagulation for proliferative diabetic retinopathy

Answer 42

Laser burns used to evenly distribute scatter pattern across entire retina except macula causing proliferating vessels to disappear

Question 43

Future drugs to prevent proliferative diabetic retinopathy (3)

Answer 43

-Avastin
-leucentis
-eylea
(all vascular endothelial growth factor inhibitors)

Question 44

Drugs that have toxic ocular effects resulting in retinopathy (5)

Answer 44

• thiorodazine
• chloroquine
• tamoxifen
• ethambutol
• fluorquinolones