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Ophthalmology > Ocular Manifestations of Systemic Disease > Flashcards

Ocular Manifestations of Systemic Disease Flashcards

1
Q

Inflammatory Eye Disease Sx

A

Red eye
Dull ache
Photosensitivity
Intact corneal epithelium (no fluorescein staining)

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2
Q

Inflammatory Eye Disease Management

A

Ophtho referral for steroid management
Usually idiopathic - warrants rheumatological workshop
Management of complications (cataracts –> surgery, glaucoma –> drops and surgery, vitritis and epiretinal membranes –> surgery)

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3
Q

Infant Anterior Uveitis

A

TORCH infections, retinoblastoma

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4
Q

Child Anterior Uveitis

A

JIA, toxocariasis, toxoplasmosis

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5
Q

Young adult Anterior Uveitis

A

HLA-B27, Fuchs heterochromic iridocyclitis, pars plainitis, idiopathic endogenous infection

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6
Q

Elderly Anterior Uveitis

A

Lymphoma, serpiginous choroidopathy, vitiliginous choroiditis, ARN, post-op infection

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7
Q

Female Anterior Uveitis

A

JIA, SLE

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8
Q

Male Anterior Uveitis

A

Ankylosing Spondylitis, reactive arthritis

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9
Q

Caucausian Anterior Uveitis

A

HLA-B27, MS, white dot syndrome

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10
Q

African American Anterior Uveitis

A

Behcet disease

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11
Q

Asian, Native American Anterior Uveitis

A

VKH syndrome

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12
Q

Inflammatory Anterior Disease

A 
Rheumatoid Arthritis
Wegener's Granulomatosis
p-ANCA vasculitides
Systemic Lupus Erythematosis
Sarcoidosis
HLB-B27 Disease--> More common in WI (psoriatic arthritis, inflammatory bowel disease, reactive arthritis, ankylosing spondylitis)
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13
Q

Inferior Corneal Melting/Rheumatoid Arthritis Management

A

Amniotic membrane replacement
Lateral tarsorraphy v. shield @ all times
Doxycycline-collagenase inhibitor
Vitamin C 1000 mg/day
Suppress systemic immune-mediated inflammation (epithelium intact?–>prednisone drops 6x/day; might start w/ 60-80mg prednisone; Immunomodulator)

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14
Q

Inflammatory Posterior Disease

A 
Rheumatoid arthritis
Granulomatosis w/ polyangitis (Wegener's)
p-ANCA vasculitis (churg-strauss)
Multiple Sclerosis
Sarcoidosis
Pars planitis
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15
Q

Lupus Vasculitis

A

Inflammatory Posterior Disease
Causes: Conjunctivitis, Cotton wool ischemic spots, Cerebral involvement

Develops over a couple of weeks

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16
Q

Temporal Arteritis

A

aka Giant Cell arteritis
Elevated ESR/CRP/platelets
Tx: High dose steroids, sometimes IV, temporal artery biopsy
Rare in people < 70yo.

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17
Q

Optic Neuritis/MS

A 
Intermediate uveitis
Typically Female 20s-40s
Pain w/ eye movement
APD
Decreased color vision
Pulfrich effect
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18
Q

Pulfrich effect

A

W/ swinging pendulum, pt perceives lateral movement as depth movement around horizontal equator. Due to affected eye perceiving motion slower than unaffected eye, causing depth perception phenomenon

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19
Q

Acute Thyroid Eye Disease

A

Signs: Eyelid swelling, conjunctival chemosis
Sx: Pain, Double vision, vision loss, constricted visual fields, loss of color vision (fairly emergent)

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20
Q

Chronic Thyroid Eye Disease

A

Signs: Upper/lower lid retraction, Proptosis, Poor extra-ocular movements
Sx: Exposure and dryness, double vision

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21
Q

Thyroid Eye Disease

A

Orbit: Reduced Volume, orbital fat expansion
Muscles: Hypertrophy of EOC muscles
Lids: Retractor muscle hypertrophy similar to rectus muscles, Lids pulled back

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22
Q

Thyroid Eye Disease Diagnosis/tests

A

TSH/Free T4 levels
Maintain euthyroid state
Optic nerve assessment (pupils, color vision, visual fields)
Muscle assessment (EOM movements, Diplopia?)
Eyelids (measurement of retraction)

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23
Q

Thyroid Eye Disease Treatment

A

Lubricate cornea
Immunosuppression (Steroids, Rituxin, Radiation)
Surgery (Orbit, Muscles, Lids)

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24
Q

Neuroblastoma

A

Unilateral black eye, poptosis and no trauma/suspicion of trauma
Dx: CT-Maxi face, adrenal masses w/ abd US, CT abd for adrenal masses

25
Q

Eyelid and Orbital Lymphoma

A

Low grade B-cell lymphoma from MALT
Orbit: Eylid mass, proptosis, 2/3 systemic
Conjunctiva: Salmon pinkish patch, 1/3 sytemic

26
Q

Eyelid and Orbital Lymphoma Mangement

A

Systemic Work up
Biopsy
Systemic: Chemo
Local: Radiation

27
Q

Intra-Ocular Lymphoma

A

Presentation: Chronic anterior uveitis, Posterior uveitis in elderly, Subretinal infiltrates
Management: Vitreous Biopsy, Brain imaging, Lumbar puncture, Local or systemic chemo (Methotrexate, rituximab)

28
Q

Metastasis

A

Most common malignancy in eye
Breast (female) and lung (male) adenocarcinoma most common
Uvea or orbit
Poorly demarcated, multiple, bilateral

29
Q

Retinoblastoma

A

Most common childhood eye cancer
Early Detection –> Eye sparing treatment
One eye w/o red reflex (large differential but consider retinoblastoma)
Related to retinoblastoma tumor suppressor gene

30
Q

Herpes Zoster Ophthalmicus

A

Caused by herpes zoster virus
Lesions on nose = Hutchinson’s Sign
Affect the entire eye (all corneal layers, anterior/posterior uveitis, retina and optic nerve)

31
Q

Herpes Zoster Ophthalmicus Management

A

Acyclovir, Valacyclovir

Refer in 3-5 days (or 1-2 days w/ pain/vision loss)

32
Q

Herpes Simplex Virus

A

Dendritis keratitis
Stromal keratitis
Anterior uveitis
Poster uveitis

33
Q

Herpes Simplex Virus Management

A

Acyclovir, Valacyclovir

Refer to ophtho

34
Q

Infectious Posterior Findings

A 
Toxoplasmosis
Syphilis
Tuberculosis
Lyme disease
Toxocariasis
35
Q

HIV/AIDS retinopathy

A

Ocular complications in 75% patients
Retinal microangiopathy (cotton wool spots)
Opportunistic infxns (CMV, pneumocystis, Toxoplasmosis, HZO)
Tumors (Kaposi’s sarcoma, Large cell lymphoma)

36
Q

Infectious CMV Retinitis

A

CD4 counts < 40
Often asymptomatic w/o pain
Starts in center or periphery but spreads (“brush-fire”)
50% progress to retinal detachment

37
Q

Infectius CMV Retinitis Tx

A

Systemic IV granciclovir or foscarnet
Cidofovir
Intravitreal granciclovir or foscarnet

38
Q

Diabetic Retinopathy Risk Factors

A 
#1: Duration of diabetes (Type 1 - refer @ year 5, Type 2 - refer @ onset)
Blood sugar levels
BP
Hyperlipidemia/cholesterol
Pregnancy
Renal disease
Anemia
39
Q

DM Nonproliferative Diabetic Retinopathy (NPDR)

A

Retinal hemorrhages
Hard exudates
Mild/Moderate/Severe

40
Q

DM Proliferative Diabetic Retinopathy

A

Neovascularization
Vitreous hemorrhage
Tractional retinal detachment

41
Q

DM Macular Edema

A

Can occur @ any stage

LEADING CAUSE OF BLINDNESS IN DIABETIC PATIENTS

42
Q

Mild/Moderate NPDR

A

Vascular disease causing ischemia and attempted to angiogenesis
Yearly Dilated Fundus Exam (microaneurysms, hemorrhages, hard exudates, cotton wool spots)

43
Q

Severe NPDR

A

Venous bleeding
Dark hemorrhages
Cotton-wool spots
Intraretinal microvascular abnormalities (IRMA)

Close follow up to watch for proliferative disease

44
Q

Diabetic Macular Edema

A

Optical Coherence Tomography (OCT) - Light waves (like US)
Fluorescein angiography: What’s leaking?
Intravitreal anti-VEGF therapy
Laser treatment (focal to leaking microaneurysms, grid to diffuse leakage)

45
Q

DM Proliferative Diabetic Retinopathy Tx

A

Pan-retinal photocoagulation (PRP)
Observation, Vitrectomy
Retinal attachment surgery

46
Q

Hypertension

A

Can cause painless vision loss (acute onset macular edema, optic nerve damage)

Management: Refer pts w/ vision loss, Control BP

47
Q

Hypertensive Retinopathy

A

Arterial changes (narrowing, copper wiring, silver wiring)
A/V crossing changes (90 degree angles, nicking)
Retinal hemorrhages
Retinal exudates (hard, macular star)
Papilledema

48
Q

Hypertension Macroaneurysms

A

Unlucky.

Congenital small aneurysms rupture w/ HTN –> poor vision

49
Q

Ischemic Optic Neuropathy

A

HTN can cause

Lead to long-term vision damage

50
Q

Central Retinal Arterial Occlusion (CRAO)

A

Unilateral painless acute vision loss
Most common cause of cherry red spot
Etiology: atherosclerosis, emboli, vasculitis, coagulopathy, collagen vasc disease, migraine
IRRIVERSIBLE DAMAGE AFTER ~100 min.

51
Q

CRAO Tx

A

ASA (tylenol)
Ocular massage
IOP reduction w/ acetazolamide
Anterior chamber paracentesis

Imaging: Carotid US, echo, MRI-brain

52
Q

Retinal Vein Occlusion (RVO)

A

Sx: Blind spot in visual field, Loss of vision, Unilateral

Associated w/: Atherosclerosis, HTN, Diabetes, Age >50, Glaucoma

53
Q

Central Retinal Vein Occlusion

A

Blood (Hemorrhage) and Thunder (Edema)

54
Q

RVO Tx

A 
Intravitreal anti-VEGF (avastin, lucentis, eylea)
Grid laser (resistant BRVO)
Intravitreal Steroid (Resistant CRVO)
55
Q

Marfan’s Syndrome

A

Inherited
Bilateral lens subluxation (non-progressive, upward)
Glaucoma
Retinal detachment (secondary to lattice degeneration)
Flat cornea
Hypoplasia of dilators

56
Q

Down’s Syndrome

A 
Inherited
Cataracts
Acute keratoconus
Nasolacrimal duct obstruction-tearing
Blepharitis
Strabismus
Nystagmus (10%)
Iris Brushfield spots
High refractive errors (hyperopia >> myopia)
57
Q

Keratoconus

A 
Ass w/ eye rubbing as child
Corneal thinning (cone shape)

Tx: FDA approved cross-linking (stops progression), hard contact lens

58
Q

Phacomatoses-Neurofibromatosis

A 
Iris Lisch nodules
Plexiform neurofibromas of eyelid
Prominent corneal nerves
Glaucoma
Choroidal hamartomas
15% have low grade optic nerve astrocytoma (glioma)
59
Q

Myotonic Dystrophy

A

long-term genetic disorder that affects muscle function
frontal balding, cognitive challenge, long face, open mouth, weak distal extremities, foot drop, CHRISTMAS TREE CATARACTS
Chromosome 19

Ophthalmology (9 decks)

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