Systemic disease

Question 1

how does diabetes damage the eye (broadly)

Answer 1

too much sugar for too long damages the blood vessels in the eye

Question 2

how does sugar damage blood vessels

Answer 2

glycosylation of proteins damage the blood vessels endothelial cells and increase vascular permeability and can cause neovascularisation

Question 3

what pathological damage can occur from diabetic retinopathy (6)

Answer 3

loss of pericytes –> micro-aneurysms –> haemorrhage –> hard exudates –> ischaemia –> cotton wool spots (nerve damage)

Question 4

what are some signs of retinopathy

Answer 4

micro-aneurysms (dots and blot haemorrhages) / hard exudates / cotton wool patches / distorted veins / intra-retinal microvascular abnormalities (IMRA) /

Question 5

what are the 3 classifications of diabetic retinopathy from mild –> severe

Answer 5

mild = no retinopathy / moderate = non-proliferative (no neovascularisation) / proliferative = neovascularisation)

Question 6

what is diabetic maculopathy

Answer 6

macular oedema and ischaemia

Question 7

what are complications of diabetic retinopathy (5)

Answer 7

Retinal detachment / Vitreous haemorrhage / Rebeosis iridis (blood vessels on iris) / Optic neuropathy / Cataracts

Question 8

how do you manage diabetic retinopathy (3)

Answer 8

laser photocoagulation / anti-VEGF / vitreoreinal surgery

Question 9

what infective inflammatory causes can affect the eyes

Answer 9

TB, HZV, syphilis, lyme disease

Question 10

what non- infective inflammatory causes can affect the eyes

Answer 10

HLA B27, arthritis, ankylosing spondylitis, sarcoidosis

Question 11

what are common symptoms of neuro-opthalmic disorders

Answer 11

eye movement defects / double vision / visual defects

Question 12

what are common causes of neuro-opthalmic disorders (5)

Answer 12

vascular most common / demyelination (MS) / trauma / tumours/ congenital

Question 13

what muscle is affected in a abducens nerve palsy

Answer 13

CN VI - lateral rectus

Question 14

what is seen when looking at patients eyes with abducens palsy

Answer 14

when abducting the eye (looking to the side) the affected eye will look straight ahead

Question 15

what muscle is affected in a trochlear nerve palsy

Answer 15

CN IV - superior oblique

Question 16

what is seen when looking at patients eyes with trochlear nerve palsy

Answer 16

affected intorsion / depressed in adduction / weak abduction

Question 17

what muscles are affected in oculomotor nerve palsy

Answer 17

CNIII - medial rectus, inferior rectus, superior rectus, inferior rectus

Question 18

what is seen when looking at patients eyes with oculomotor nerve palsy

Answer 18

down and out

Question 19

what is internuclear opthalmoplegia

Answer 19

impaired horizontal movement

Question 20

what causes internuclear opthalmoplegia

Answer 20

MS and vascular causes

Question 21

where is the problem in internuclear opthalmoplegia

Answer 21

connection between 3rd and 6th nerve damaged - medial longitudinal fasciculus

Question 22

what is optic neuritis

Answer 22

affects the optic nerve and causes progressive unilateral visual loss

Question 23

what is optic neuritis associated with

Answer 23

MS

Question 24

what are symptoms of MS

Answer 24

colour desaturation and pain behind eye

Question 25

what can cause visual defects resulting in optic nerve visual loss

Answer 25

ischaemic optic neuropathy / optic neuritis / tumours

Question 26

if optic nerve is damaged what visual loss occurs

Answer 26

unilateral vision loss

Question 27

what can cause visual defects resulting in optic chiasm visual loss

Answer 27

PIT TUMOURS / craniopharyngioma / meningioma

Question 28

if optic chiasm is damaged what visual loss occurs

Answer 28

bitemporal hemianopia

Question 29

what can cause visual defects resulting in optic tract and radiations visual loss

Answer 29

tumours / demyelination / vasular

Question 30

if optic tract and radiations are damaged what visual loss occurs

Answer 30

quadrants or contralateral