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Ophthalomology > Systemic Disease > Flashcards

Systemic Disease Flashcards

0
Q

Ocular complications of diabetes can be reduced by

A

Early detection/monitoring
Good diabetic control
Modification of risk factors - blood sugars, lipids, blood pressure, stop smoking

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1
Q

Ocular complications of diabetes

A 
Diabetic retinopathy
Diabetic maculopathy
Extra-ocular muscle palsy
Retinal vascular occlusions 
Cataracts
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2
Q

Diabetic retinopathy

A

Characteristic retinal abnormalities that occur throughout the retina
Include retinal micro-haemorrhage, exudates (hard exudate are lipid deposits), cotton wool spots

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3
Q

Diabetic maculopathy

A

Characteristic macula abnormalities
Most commonly macula oedema, exudates, retinal thickening and ischaemia
Starts with slight central visual loss but is often progressive
Major cause of vision loss in diabetic retinopathy

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4
Q

Macula oedema is clinically significant, and should be treated if

A
  1. If there is retinal thickening/exudates within 1/3 optic disc diameters from the centre of the macula
  2. If there is one disc area of retinal thickening or more, part of which is within one disc area of the centre of the macula
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5
Q

Diabetic extra-ocular muscle palsy

A

Diabetes can cause an isolated 3rd, 4th or 6th nerve palsy with pain around the eye
Diabetic 3rd nerve palsy spares the pupillary function

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6
Q

Diabetes and cataracts

A

Posterior subcapsular cataracts are frequently seen in diabetics

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7
Q

Diabetic retinopathy - risk in diabetic patients

A

20yrs after diagnosis 95-100% type 1s and 60% of type 2s will show retinopathy
30 years after diagnosis 30% of type 1 and 3% type 2 will have proliferative disease

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8
Q

Proliferative disease (proliferative diabetic retinopathy)

A

new vessel growth in the disc and elsewhere in the retina

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9
Q

Loss of sight in diabetes can be due to

A 
Macula oedema
Macula ischaemia
Haemorrhage from new vessels
Tractional retinal detachment
Field loss due to laser treatment
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10
Q

Causes of diabetic retinopathy

A

Its due to hyperglycaemia
Clinical signs are due to small vessel occlusion, increased vascular permeability and changes in vessel walls die to loss of pericyte cells
Proliferative disease is caused by VEGF from ischaemic retina

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11
Q

Vitreous haemorrhage

A

Second most common cause of visual loss in diabetic retinopathy
Can cause acute vision loss and floaters

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12
Q

Retinal signs of diabetic retinopathy

A 
Micro-aneurysms
Dot & blot haemorrhages
Exudates & Cotton wool spots 
Retinal oedema and thickening
Neovascular and venous changes --> new vessels at the disc (NVD) and elsewhere (NVE)
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13
Q

Ocular ischaemia syndrome

A

A rare disease which occurs as a result of atherosclerotic vessels, generally the internal carotids.
The resulting ischaemia causes retinopathy and produces similar signs to diabetic micro vascular ischaemia

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14
Q

Investigating diabetic retinopathy

A

Duration and type of diabetes - HbA1c
Smoking
Other diabetes associated disease
Visual symptoms and past eye disease/treatment
Check red reflex for cataracts then dilated fundoscopy

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15
Q

Management of diabetic retinopathy

A

Screening of diabetic patients
Control diabetes and risk factors
Refer to ophthalmologist if - severe non-proliferative/proliferative retinopathy or maculopathy

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16
Q

Treatment of diabetic retinopathy

A

Classify the retinopathy - monitor. Treat any associated disease
PRP for new vessel growth,
Focal macula laser to reduce macula oedema, also Intravitreal anti-VEGF injections (ranibizumab) but multiple may be needed
Vitrectomy surgery is occasionally used for vitreous haemorrhage or relieve tractional retinal detachment

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17
Q

fluorescein angiography

A

Used to identify leaking new blood vessels and oedema

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18
Q

Classification of diabetic retinopathy

A

Mild non-proliferative DR -> Moderate non-proliferative DR ->
Severe non-proliferative DR -> Very severe non-proliferative DR ->
Non-high risk proliferative DR -> High risk proliferative DR -> Advanced proliferative DR -> Maculopathy

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19
Q

More recently UK ophthalmologists have started using

A 
A system like tumour grading
Retinopathy - R0, R1, R2, R3 or R4
Maculopathy - M0 or M1
Photocoagulation - P0 or P1
Unclassifiable - U
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20
Q

Thyroid eye disease - introduction

A

An inflammatory disease affecting the extra ocular muscle and the orbital connective tissues
There is an initial inflammatory stage followed by an inactive fibrotic state

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21
Q

Thyroid eye disease - epidemiology

A

An idiopathic autoimmune disorder - usually associated with hyperthyroidism but can occur in normal or hypothyroid
Peak incidence at 30-50yrs, more common in women
Worst cases are smokers, males and older people
Can lead to sight threatening optic neuropathy or exposure keratopathy

22
Q

NOSPECS

A

A classification of the severity of symptoms:

(1) No symptoms or signs (5) Extraocular muscle palsy
(2) Only lid retraction +- lid lag (6) Corneal disease
(3) Soft tissue involvement (7) Sight threatening optic
(4) Proptosis Neuropathy

23
Q

Thyroid eye disease - symptoms

A

Conjunctival injection & redness
Dryness, watering
Photophobia, Visual loss & Diplopia

24
Q

Thyroid eye disease - history

A

Smoking

Family history of thyroid eye disease

25
Q

Thyroid eye disease - signs

A

Conjunctival inflammation/chemosis
Upper lid retraction +- lid lag on looking down
Proptosis and Lagophthalmos
Reduced eye movements due to muscle palsies (inferior rectus)
If severe - Exposure keratopathy and optic neuropathy

26
Q

Proptosis

A

Forward bulging of the globe in the orbit

27
Q

Lagophthalmos

A

Inability to completely close the lids

28
Q

Exposure keratopathy

A

Drying of the inferior part of the cornea due to incomplete lid closure

29
Q

Symptoms of optic neuropathy

A

Reduced visual acuity
Reduced colour vision
Visual field defects

30
Q

Thyroid eye disease - Investigations

A

Thyroid function tests and TSH

CT of orbit if uncertain, or to check for optic nerve compression

31
Q

Thyroid eye disease - management

A

Refer to endocrinologist to manage systemic thyroid disease
Exposure keratopathy –> artificial tears
Elevate the head at night if eyelid oedema is a problem
May require systemic steroids –> must monitor IOP
Radiation can be used if that doesn’t work

32
Q

Ocular symptoms of MS

A

Optic neuritis –> inflammation of the optic nerve is common symptom of MS
visual field defects
Cranial nerve palsies -> most commonly the 6th
Nystagmus

33
Q

Optic neuritis in MS

A

Dysfunction developing over hours/days - painful eye movement
Variable reduction in visual acuity, Visual field defects & reduced colour vision (red desaturation because red vision goes first)
Typically 18-45yrs
Uhotoff’s sign

34
Q

Uhtoff’s sign

A

Worsening of symptoms on exercise or increased body temperature –> symptoms are worse in the bath

35
Q

Optic neuritis in MS - signs

A

RAPD
Colour vision defect
Visual field defect
May have swollen optic discs –> may not if inflammation is further back –> retrobulbar optic neuritis

36
Q

Optic neuritis in MS - investigations

A

Ask about - age, duration/nature of visual loss, previous episodes, pain on moving the eye

Check for any other focal neurological signs

37
Q

Optic neuritis in MS - management

A

Quantify deficit –> test pupils and eye movements, check level of red desaturation, confrontation visual field testing, fundoscopy
Full neurological exam
Refer to neurology –> MRI to confirm

38
Q

Ocular problems in immunocompromised patients

A

Most commonly due to HIV –> varies with severity of compromise/infection
CD4 count >1000cells/mL is normal, CD4 count <50 is very low with high risk of CMV retinitis or other infections

39
Q

When seeing a patient with HIV about their eyes you should check

A

Acuity and function
Eyelids and the external eye
Dilated fundoscopy including the peripheral retina

Ask about systemic illnesses and duration of HIV

40
Q

CMV retinitis

A

Normally causes subacute infections in the salivary glands
Ocular infections only in the immunocompromised
On fundoscopy:
Para-vascular (following the vessels) opacification with associated haemorrhage

41
Q

Blepharitis

A

An eye condition characterised by chronic inflammation of the eyelid which is usually self-limiting
Can be caused by staphylococcal species
Presents with sticky debris at eyelash roots, secondary punctate corneal erosions and may have conjunctival hyperaemia

42
Q

Mollescum contagiosum

A

A condition caused by a poxvirus infection causing a small eyelid nodule, mild mucoid discharge and an inferior fornix follicle
Occurs in immunocompromised and immunocompetent patients
Consider in cases of recurrent or refractory conjunctivitis

43
Q

HIV retinopathy

A

A condition characterised by retinal possible micro-haemorrhages with cotton wool spots on fundoscopy
A rare condition of unclear Pathophysiology

44
Q

Toxoplasmosis of the retina

A

Common parasitic infection which is only active in the retina of immunocompromised patients
On fundoscopy: dark areas of older disease and active disease appearing as white retinitis
Spread by cats

45
Q

Conjunctival kaposi sarcoma

A

A condition characterised by a red-violent nodule on the eyelid which is associated with HIV

46
Q

Hypertensive retinopathy

A

Similar to hypertensive changes elsewhere in the body but easier to see
A serious complication of uncontrolled hypertension

47
Q

Hypertensive retinopathy - fundoscopy signs

A

cotton wool spots due to retinal ischaemia
hard yellow lipid exudates, ‘copper and silver wiring’
flame haemorrhages in the retinal nerve fibre layer
macro-aneurysms (red dots), macula oedema, optic disc swelling, venous nipping at arteriovenous crossings,

48
Q

Symptoms of hypertensive retinopathy

A

Usually asymptomatic but can experience visual loss

49
Q

Copper and silver wiring

A

A fundoscopy sign of hypertensive retinopathy
Vessels have an altered reflex giving a different appearance
A hard sign to detect in practice

50
Q

Differential diagnosis for hypertensive retinopathy

A

Ask about control and measure blood pressure
Diabetic retinopathy –> exclude by history and check BM
Diabetic/hypertensive retinopathy look similar and can co-exist
Consider Retinal vein occlusion

51
Q

Hypertensive retinopathy - treatment

A

Control blood pressure

52
Q

Hypertensive retinopathy - classifications

A

Grade 0 - normal
Grade 1 - arteriolar narrowing
Grade 2 - focal arteriolar narrowing + arteriovenous nipping
Grade 3 - haemorrhages, exudates and cotton wool spots
Grade 4 - grade 3 but with disc swelling

Ophthalomology (11 decks)

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