Systemic Disease and the Eye Flashcards
what are the features of neuro-ophthalamic disease
Eye movement defects – double vision
Visual defects - visual acuity, field loss
Ix of eye when trying to discover systemic cause
MRI
what is the most common systemic disease that has an effect on the eyes
Vascular disease
what is the most common nerve palsy
VIth nerve palsy
what happens in a VIth nerve palsy
Lateral Rectus stops working and cannot abduct eye.
Eye stuck in adduction as medial rectus works unopposed
what can cause a VIth nerve palsy
Microvascular; tend to be a few capillaries getting blocked in this case. Only knocking out one nerve. Usually resolve in a few months.
Raised Intracranial pressure
Tumour
Congenital
sudden onset 6th nerve palsy + headache = ?
raised intracranial pressure
what would be seen with raised intracranial pressure
bilateral papilloedema
what is the second most common nerve palsy that is mostly due to congenital problems
IVth nerve palsy
what muscle stops working in IVth nerve palsy
Superior Oblique
what are the functions of the SO muscle
intorsion
depression in adduction
abduction (weak)
what is a sign seen in IV nerve palsy
head tilt
what can cause IV nerve palsy
Congenital decompensated
Microvascular
Tumour
Bilateral – closed head trauma
what are clinical features of IV nerve palsy
torsion
chin depressed
what can cause a IIIrd nerve palsy
Microvascular (most common) Tumour Aneurysm (surgical emergency - classical cause for acute emergency palsy) MS Congenital
how can you differentiate a 3rd nerve palsy caused by an aneurysm
Painful + Dilated pupil
what is Inter-nuclear Ophthalmoplegia
eye shows impairment of adduction
what happens in INO
When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally, if at all. The contralateral eye abducts, however with nystagmus. Additionally, the divergence of the eyes leads to horizontal diplopia. That is, if the right eye is affected the patient will “see double” when looking to the left, seeing two images side-by-side.
what are common causes of INO
MS
Vascular
what can affect the optic nerve
Ischaemic Optic Neuropathy Optic neuritis – commonly MS Tumours - rare -Meningioma -Glioma -Haemangioma
what are symptoms of optic neuritis
Progressive visual loss (unilateral)
Pain behind eye, especially on movement
Colour desaturation
Central scotoma (gap in visual field)
Tx of optic neuritis
Prednisone
OR
leave alone - gradual recovery, weeks to months
what can occur after optic neuritis
optic atrophy
what can affect the optic chiasm
Pituitary tumour
Craniopharyngioma; very rare, affects children
Meningioma
what does a tumour at the optic chiasm cause
Bi-temporal field defect
what would the investigation of suspected tumour at optic chiasm be
MRI
vision loss is commonly reversed after tumour is removed from pituitary - true or false
True
what can affect the optic tracts
Tumours (primary or secondary)
Demyelination
Vascular anomalies
what does problems in the optic tracts cause
Homonomous defects
Macula not spared
Quadrantanopia
what can affect the occipital cortex
Vascular disease (CVA) Demyelination
what does problems at the occipital cortex cause
Homonomous defect
Macular sparing
what is seen in an eye affected by diabetic retinopathy
vascular occlusion»_space; proliferative retinopathy
vitreous haemorrhage
cotton wool spots
hard exudates
Intra-retinal microvascular abnormailities (IRMA)
Dot + Blot haemorrhages
Flame shaped haemorrhages
tortuous veins
what does vascular occlusion cause
ischaemia +/- new vessels in the retina, optic disc and iris i.e. proliferative retinopathy
cotton wool spots (ischaemic nerve fibres)
what happens when these new vessels bleed in proliferative retinopathy
vitreous haemorrhage
what does diabetic retinopathy changes put the eye at risk to
retinal detachment
what causes dot/blot/flame haemorrhages
dots - micro-aneurysm
blot + flame - haemorrhages
how can diabetic patients lose vision
from:
- retinal oedema affecting the fovea
- vitreous haemorrhage
- scarring/ tractional retinal detachment
what are the classifications of diabetic eye disease
Classification 1: non-proliferative retinopathy
Classification 2: proliferative retinopathy
Classification 3: maculopathy
what are the features of NPR
dots haemorrhages/micro-aneurysm flamed shape/blots haemorrhages hard exudates engorged to tortuous veins cotton wool spots
what are features of proliferative retinopathy
same as NPR
BUT with new vessels appearing on optic disc and retina
can cause vitreous haemorrhage
what is seen in maculopathy
oedema of optic disc
can threaten sight
how do hard exudates appear on fundoscopy
yellow patches
Mx of diabetic retinopathy
Optimise medical management
Laser
- proliferative retinopathy - pan retinal laser
- Maculopathy - grid or focal laser treatment
Surgery – vitrectomy to treat vitreous haemorrhage
how is diabetic macular oedema treated
Intravitreal Triamcinolone
Anti-VEGF drug
along with laser treatment
what can occur as a complication of diabetic retinopathy
CN III or VI palsy
what are features of hypertensive retinopathy
Attenuated blood vessels-copper or silver wiring cotton wool spots hard exudates flame haemorrhage optic disc oedema
what is amaurosis fugax
emboli to the retina causes a ‘curtain passing across the eyes’
what are Roth spots
retinal infants of infective endocarditis
how does central retinal artery occlusion present
Sudden painless loss of vision
very profound loss of vision
retina appears white with a ‘cherry red’ spot at the macula
rarely recovers
how does central retinal vein occlusion present
Sudden painless visual loss
Range of visual loss- from profound to reasonably okay
need to determine degree of ischaemia - correlates to degree of reduced vision and fundal appearances
in diabetes, what can make retinopathy worse
pregnancy dyslipidaemia increase BP renal disease smoking anaemia
how does a branch vein occlusion differ in presentation
unilateral vision loss
Painless disturbance in vision
may be assymptomatic
may be aware of loss of part of field - branch affect correlates with division of vision lost
how does the retina appear in the different occlusions
artery occlusion - retina very pale, white
vein - blood builds up, very dark
what can happen as a result of a vein occlusion
retinal ischaemia»_space; VEGF released»_space; new retinal vessel formation
how is neovasculation treated
laser photocoagulation
what are infective inflammatory diseases that can cause uveitis
TB Herpes Zoster Toxoplasmosis Candidiasis Syphilis Lyme Disease
what are non-infective inflammatory diseases that can cause uveitis
Idiopathic
Juvenile Arthritis
Sarcoidosis
Behcet’s Disease
what eye condition is RA associated with
scleritis
what is PMR associated with that can cause blindness
Giant Cell Arteritis
what can GCA present with
headache
jaw claudication
malaise
raised PV
what eye conditions are seen in SLE
Conjunctivitis
Episcleritis
what eye conditions are seen in RA
Dry eyes (Keratoconjunctivitis Sicca)
Scleritis
Corneal melt
triad seen in Sjogren’s syndrome
- keratoconjunctivitis sicca
- xerostomia (dry mouth)
- Rheumatoid Arthritis (usually)
Ix for suspected Sjogren’s syndrome in relation to the eyes
Schirmer test
Tx for Sjogren’s
Pilocarpine and Cevimeline - dry mouth
Ciclosporin - dry eyes
eye features of Stevens-Johnson syndrome
Symblepharon
occlusion of lacrimal glands
corneal ulcers
what is Symblepharon
partial or complete adhesion of the palpebral conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball
