Systemic conditions causing eye signs

Question 1

What is anterior uveitis/iritis?

Answer 1

Inflammation of the front chamber of the eye

Question 2

What is posterior uveitis/choroiditis?

Answer 2

Inflammation of the back chamber of the eye

Question 3

What group of conditions cause iritis/choroiditis?

Answer 3

Granulomatous disorders- syphilis, TB, sarcoidosis, leprosy, brucellosis and toxoplasmosis

Question 4

What ocular features may be seen in Reiter’s?

Answer 4

Iritis and/or conjunctivitis

Question 5

What is episcleritis?

Answer 5

Inflammation of the episclera, which lies between the conjunctiva and the sclera

Question 6

What conditions may cause episcleritis/scleritis?

Answer 6

RA
Vasculitis
SLE

Question 7

What is the possible impact of giant cell arteritis on the eye?

Answer 7

Optic nerve ischaemia presenting as sudden blindness

Question 8

What is keratoconjunctivitis sicca?

Answer 8

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).

Question 9

In what conditions is keratoconjunctivitis sicca seen?

Answer 9

• May occur on it’s own (Sjogren’s syndrome)

- May occur with other diseases e.g. SLE, RA and sarcoidosis

Question 10

How is keratoconjunctivitis sicca treated?

Answer 10

Artificial tears/saliva

Question 11

What causes hypertensive retinopathy?

Answer 11

Increased BP accelerates atherosclerosis in retinal vessels

Question 12

Describe the appearance of hypertensive retinopathy

Answer 12

• 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

Question 13

What might be suggested by papilloedema in the context of retinopathy?

Answer 13

Accelerated hypertension

Question 14

What sign of infective endocarditis is seen in the eye?

Answer 14

Roth spots- small retinal infarcts

Question 15

What signs of dermatomyositis are related to the eye?

Answer 15

• Lilac-purple heliotrope rash on the eyelid
• Peri-orbital oedema
• Retinopathy showing cotton-wool spots caused by micro-infarcts

Question 16

What might be caused by emboli passing through the retinal vasculature?

Answer 16

Retinal artery occlusion- retinal pallor corresponds to the area affected so may be global or segmental

Amaurosis fugax

Question 17

What are the risk factors for retinal vein occlusion?

Answer 17

High BP
Old age
Hyperviscosity

Question 18

When should retinal vein occlusion be suspected?

Answer 18

In any acute fall in visual acuity

Question 19

How is the fundus of the eye describe if there is central retinal vein occlusion?

Answer 19

“Like a stormy sunset” the “angry red clouds” are haemorrhages

Question 20

In what condition do retinal haemorrhages occur?

Answer 20

Leukaemia

Question 21

What eye features are associated with sickle-cell disease?

Answer 21

Comma-shaped conjunctival haemorrhages

Retinal new vessel formation

Question 22

In what conditions is optic atrophy seen?

Answer 22

Pernicious anaemia

MS

Question 23

What eye feature is associated with hyperthyroidism?

Answer 23

Exopthalmos

Question 24

What eye feature is associated with hypoparathyroidism?

Answer 24

Lens opacities

Question 25

What eye feature is associated with hypercalcaemia?

Answer 25

Conjunctival and corneal calcification

Question 26

Why can sore eyes occur in gout?

Answer 26

Conjuctival urate deposits

Question 27

What eye symptom can occur with septicaemia?

Answer 27

Septicaemia may spread to the vitreous humour causing endopthalmitis

Question 28

What eye symptom can occur with syphilis?

Answer 28

Iritis (+ pigmemented retinopathy if congenital)

Question 29

In what groups of people might systemic fungal infections affect the eye?

Answer 29

Immunocompromised e.g. HIV+ | IV drug users

Question 30

How are systemic fungal infections of the eye treated?

Answer 30

Intra-vitreal antibiotics

Question 31

What eye symptoms can occur with HIV?

Answer 31

- 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)

Question 32

How is acute glaucoma treated?

Answer 32

IV acetazolamide + pilocarpine drops

Question 33

Describe the appearance of the eye in iritis

Answer 33

- Redness most marked around the cornea - Redness doesn't blanch on pressure - Usually unilateral - Pupil is small and irregular

Question 34

Describe the appearance of the eye in glaucoma?

Answer 34

- 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

Question 35

What conditions cause iritis?

Answer 35

- AS - RA - Reiter's - Sarcoidosis - Herpes simplex - Herpes zoster

Question 36

How is iritis treated?

Answer 36

Steroid eye drops + mydriatic (drug which dilates the pupil)

Question 37

Describe the appearance of the eye in conjuctivitis?

Answer 37

- Bilateral - Conjunctival vessels injected, greatest towards the fornices but blanching on pressure - Purulent discharge - Normal pupil

Question 38

How is conjunctivits treated?

Answer 38

- Often no treatment is required | - Consider chloramphenicol ointment or drops

Question 39

What are the causes of subconjunctival haemorrhage?

Answer 39

``` Raised BP Leptospirosis Bleeding disorders Trauma Snake venom Haemorrhagic fevers ```

Question 40

Describe the appearance of the eye if there is a subconjunctival haemorrhage?

Answer 40

Bright red sclera with white rim around the limbus

Question 41

How is subconjunctival haemorrhage treated?

Answer 41

- Resolves spontaneously - Check BP if elderly - Is the patient on warfarin? Review this