Systemic Disease Flashcards
What is Hutchinson’s sign?
A lesion on the tip of the nose, indicates that intraocular involvement is likely via the nasociliary nerve
Management of varicella zoster opthalmicus
Topical: Potassium permanganate soaks to skin, flamazine ointment for pain and chloramphenicol ointment for eyelid lesion
Systemic: acyclovir 800mg po 5xdly for 7 days
Analgesia: amitriptyline 50-150mg nocte
Refer if VA affected or painful red eye
Commonest eye infection in HIV
CMV retinitis
Treatment of CMV retinitis
Weekly intravitreal ganciclovir
How does a squamous carcinoma of the conjunctiva present?
- looks like a pterygium
- becomes very raised and keratinised
- grows rapidly
- does not respond to topical lubricants/NSAIDS
When is B plaque irradiation used?
Following excision of squamous Ca conjunctiva
Helps prevent recurrence and invasion
Cidofovir can cause …
Uveitis and hypotony
Rifabytin can cause
Uveitis
Didanosine can cause
Midperipheral pigmentary retinopathy
HAART can cause
Immune recovery uveitis if pre-existing CMV is present
Features of thyroid associated ophthalmopathy
- lid retraction
- exophthalmos
- lid lag
- red gritty eye
- lid and conjunctival swelling
- visual loss secondary to optic nerve compression
Risk factors for progressive thyroid associated ophthalmopathy
- any history of cigarette smoking
- radioactive iodine without steroid cover
- poor thyroid hormone control
Systemic management of TAO
- persuade patient to stop smoking
- treat dry eye symptomatically
- control thyroid status
- give prednisone with radioactive iodine
- refer to ophthalmology for radiotherapy and immunosuppression if severe active eye disease
When to refer for thyroid disease
New onset:
- exophthalmos
- diplopia
- loss of vision
Syphilis can cause:
- chancre of lid
- interstitial keratitis
- uveitis
- chorioretinitis
- optic neuritis
- optic atrophy
What is scleritis associated with?
- RA
- SLE
- Wegener’s granulomatosis
- relapsing polychondritis
- other granulomatous and vasculitic diseases
What is non-granulomatous uveitis associated with?
Seronegative spondylo-arthropathies
What is granulomatous uveitis associated with?
- TB
- syphilis
- sarcoid
- leprosy
- Brucella
Features of JIA and uveitis
- blindness without eye pain or redness
Which types of JIA carry the greatest risk?
- pauciarticular
- RF neg, ANA pos
Conditions associated with atopy
- atopic conjunctivitis
- cataract
- keratoconus
- poor resistance to herpes simplex
Pathophysiology of pemphygoid and SJS
- cause corneal scarring by destroying conjunctival goblet cells and lacrimal gland orifices
Management of pemphygoid and SJS
- lubricate!
- refer early
Drugs with ocular side effects
- steroids
- ethambutol, isoniazid and streptomycin
- chloroquine
- sympathomimetics
- anticholinergics
- amiodarone and digoxin
What ocular side effects can steroids cause?
- cataract
- glaucoma
- topical can cause corneal melt, perforation and blindness in presence of herpes
What can TB meds cause?
- loss of central and colour vision
- due to toxic optic neuropathy
What can chloroquine cause?
- central blindness
- bulls eye maculopathy
- innucuous corneal deposits
Management of a patient on chloroquine
- refer for visual field test at commencement of therapy
- again after 4 years of treatment
Which drugs can precipitate angle-closure glaucoma?
- sympathomimetics (psudoephedrine, adrenaline)
- antichol (amitriptyline, antihistamines, atropine)
What can amiodarone cause?
- optic neuropathy
- innocuous corneal deposits
What can digoxin cause?
- xanthopsia (yellow vision)
Side effects of B-blockers
- tiredness and impotence
- contraindicated in asthma, heart block and PVD
Side effects of acetazolomide
- lassitude
- paraesthesiae
- renal stones
- impotence
Side effecs of A2 agonists
- tiredness
- respiratory arrest in babies
Side effects of pilocarpine
scoline apnoea
Ocular signs in myaesthenia gravis
- ptosis
- diplopia
Ice test
ptosis improves after crushed ice held on the lid for 2 minutes in myaesthenia gravis
Ocular associations in Marfan’s syndrome
- dislocated lens
- retinal detachemtn
- thoracic aortic aneurysms
Other things to look out for with psuedoxanthoma elasticum
- HT
- renovascular disease
- GIT haemorrhage
- aortic aneurysm
Retinal features of malignant hypertension
- haemorrhages
- cotton wool spots
- dilated tortuous vessels
NB when managing malignant hypertension
- dont drop BP rapidly with nefedipine
- risk of ischaemic optic neuropathy
Features of neurofibromatosis
- Lisch nodules on iris
- plexiform neurofibroma of orbit
- cafe au lait spots
Features of albinism
- high myopia
- astigmatism
- nystagmus
- VA <6/36
Features of congenital rubella
- corneal opacity
- cataract
- glaucoma
- retinopathy
- microphthalmia
Management of congenital rubella
Refer Day 1 after birth if abnormal red reflex
