Systemic conditions causing eye signs Flashcards
What is anterior uveitis/iritis?
Inflammation of the front chamber of the eye
What is posterior uveitis/choroiditis?
Inflammation of the back chamber of the eye
What group of conditions cause iritis/choroiditis?
Granulomatous disorders- syphilis, TB, sarcoidosis, leprosy, brucellosis and toxoplasmosis
What ocular features may be seen in Reiter’s?
Iritis and/or conjunctivitis
What is episcleritis?
Inflammation of the episclera, which lies between the conjunctiva and the sclera
What conditions may cause episcleritis/scleritis?
RA
Vasculitis
SLE
What is the possible impact of giant cell arteritis on the eye?
Optic nerve ischaemia presenting as sudden blindness
What is keratoconjunctivitis sicca?
A reduciton in tear formation tested by the Schirmer filter paper test (<5mm in 5 minutes). It causes a gritty feeling in the eyes and a dry mouth (xerostomia from reduced saliva production).
In what conditions is keratoconjunctivitis sicca seen?
- May occur on it’s own (Sjogren’s syndrome)
- May occur with other diseases e.g. SLE, RA and sarcoidosis
How is keratoconjunctivitis sicca treated?
Artificial tears/saliva
What causes hypertensive retinopathy?
Increased BP accelerates atherosclerosis in retinal vessels
Describe the appearance of hypertensive retinopathy
- Hardened arteries appear shiny “silver wiring”
- They ‘nip’ veins where they cross (AV nipping)
- Narrowed arterioles may become blocked causing localised retinal infarction seen as cotton wool spots
- Leaks from these in severe hypertension manifest as hard exudates or macular oedema
What might be suggested by papilloedema in the context of retinopathy?
Accelerated hypertension
What sign of infective endocarditis is seen in the eye?
Roth spots- small retinal infarcts
What signs of dermatomyositis are related to the eye?
- Lilac-purple heliotrope rash on the eyelid
- Peri-orbital oedema
- Retinopathy showing cotton-wool spots caused by micro-infarcts
What might be caused by emboli passing through the retinal vasculature?
Retinal artery occlusion- retinal pallor corresponds to the area affected so may be global or segmental
Amaurosis fugax
What are the risk factors for retinal vein occlusion?
High BP
Old age
Hyperviscosity
When should retinal vein occlusion be suspected?
In any acute fall in visual acuity
How is the fundus of the eye describe if there is central retinal vein occlusion?
“Like a stormy sunset” the “angry red clouds” are haemorrhages
In what condition do retinal haemorrhages occur?
Leukaemia
What eye features are associated with sickle-cell disease?
Comma-shaped conjunctival haemorrhages
Retinal new vessel formation
In what conditions is optic atrophy seen?
Pernicious anaemia
MS
What eye feature is associated with hyperthyroidism?
Exopthalmos
What eye feature is associated with hypoparathyroidism?
Lens opacities
What eye feature is associated with hypercalcaemia?
Conjunctival and corneal calcification
Why can sore eyes occur in gout?
Conjuctival urate deposits
What eye symptom can occur with septicaemia?
Septicaemia may spread to the vitreous humour causing endopthalmitis
What eye symptom can occur with syphilis?
Iritis (+ pigmemented retinopathy if congenital)
In what groups of people might systemic fungal infections affect the eye?
Immunocompromised e.g. HIV+
IV drug users
How are systemic fungal infections of the eye treated?
Intra-vitreal antibiotics
What eye symptoms can occur with HIV?
- CMV retinitis: pizza-pie fundus- a mixture of cotton wool spots, infiltrates and haemorrhages
- May be asymptomatic but can cause sudden visual loss
- If present implies AIDS
- Cotton wool spots on their own indicate HIV retinopathy and may occur in early disease
- Kaposi’s sarcoma may affect the lids (non-tender purple nodule) or conjunctiva (red fleshy mass)
How is acute glaucoma treated?
IV acetazolamide + pilocarpine drops
Describe the appearance of the eye in iritis
- Redness most marked around the cornea
- Redness doesn’t blanch on pressure
- Usually unilateral
- Pupil is small and irregular
Describe the appearance of the eye in glaucoma?
- Both ciliary and conjuctival vessels are injected (ciliary/conjunctival hyperemia- hyperemia is engorgement of a vessel due to increased blood)
- Entire eye is red
- Pupil is dilated and fixed
What conditions cause iritis?
- AS
- RA
- Reiter’s
- Sarcoidosis
- Herpes simplex
- Herpes zoster
How is iritis treated?
Steroid eye drops + mydriatic (drug which dilates the pupil)
Describe the appearance of the eye in conjuctivitis?
- Bilateral
- Conjunctival vessels injected, greatest towards the fornices but blanching on pressure
- Purulent discharge
- Normal pupil
How is conjunctivits treated?
- Often no treatment is required
- Consider chloramphenicol ointment or drops
What are the causes of subconjunctival haemorrhage?
Raised BP Leptospirosis Bleeding disorders Trauma Snake venom Haemorrhagic fevers
Describe the appearance of the eye if there is a subconjunctival haemorrhage?
Bright red sclera with white rim around the limbus
How is subconjunctival haemorrhage treated?
- Resolves spontaneously
- Check BP if elderly
- Is the patient on warfarin? Review this
