Systemic Disease And The Eye Flashcards
Surgical sieve of aetiologies of eye pathologies
Vascular - main one Tumour Trauma Demyelination Inflam/infection Congenital
Ix for CNVI nerve palsy
Cover test
Causes of CNVI palsy
Microvascular (most common)
Raised ICP (false localising sign)
Tumour
Congenital
Nerve responsible for intorsion- keeping eye straight when wiggle head
CNIV
Clinical features of CNIV bilateral palsy
Cause of it -
Torsion and chin depressed
Blunt head trauma
Causes of a CNIV palsy
Congenital decompensated (most common)
Microvascular
Tumour
Blunt head trauma (if bilateral)
If pupil is involved in CNIII palsy then you must rule out ___
An aneurysm
Causes of CNIII palsy
Microvascular (most common if pupil not involved) Tumour Aneurysm (if pupil involved) MS Congenital
Common site of internuclear ophthalmoplegia
Medial longitudinal fasciculus
Between nuclei of CNIII and VI
Causes of internuclear ophthalmoplegia
MS
Vascular
Demyelination
Stroke
Optic nerve pathology:
complete visual field loss can be caused by ___
visual field loss that abides by the horizontal can be caused by ___
tumour compressing nerve
vascular causes
optic neuritis of the optic nerve is commonly caused by
MS
tumours of the optic nerve (these are rare)
glioma
meningioma
haemangioma
4 features of optic neuritis
unilateral progressive vision loss
pain behind the eye esp on movement
colour desaturation
central stromata
Rx for optic neuritis
none really - resolves over weeks/months
Ix for optic neuritis and their appearance
MRI - inflamed optic nerve and maybe demyelination of white matter
fundoscopy - optic disc atrophy possibly - looks pale and featureless
pathology that can affect the optic chiasm (3)
pituitary tumour
craniopharyngioma
meningioma
pathologies of the optic tract and radiations cause what kinds of visual field losses
homonomous
macula not spared
quadrantanopia
incongruous
optic tract and radiations can be affected by which pathological processes?
tumours
demyelination
vascular abnormalities
optic cortex can be affected by which pathological processes?
vascular disease (CVA)
demyelination
abscess
pathologies of the optic cortex cause what kinds of visual field losses
homonomous
macular spared
congruous
microaneurysms are visible on ophthalmoscope when they are ___ in size
20microns
signs of non-proliferative diabetic retinopathy
microaneurysms dot+blot haemorrhages hard exudate cotton wool spots venous calibre abnormalities IRMA
signs of proliferative diabetic retinopathy
neovasculisation of the disc (NVD) or peripherally (NVE)
if severe ischaemia the rubeosis iridis
rubeosis iridis =
neovasculisation of the iris - sign of severe ischaemia
causes of loss of vision in diabetics
retinal oedema affecting the fovea
vitreous haemorrhage
acrring/tractional retinal detachment
Rx for diabetic retinopathy
optimise diabetic management
laser - PRP/macular grid (reduce demand)
Sx (vitrectomy)
rehab if blind/partially sighted
features of hypertension in the eye
attenuated blood vessels (copper/silver wiring) cotton wool spots hard exudate retinal haemorrhage optic disc oedema
___ spot is a feature of CRAO due to ___
cherry red spot
pink choroid shows through retina as the rest of the retinal nerve fibre layer becomes swollen except at the fovea
___ in CRVO correlates to reduction in vision and fundal appearance
degree of ischaemia
VEGF being pumped out to the iris if CRVO causes extensive ischaemia =>
rubeousis iridis
BRVO => ____ disturbance of vision, may be ___
painless
asymptomatic
2 classes of causes of uveitis and some examples
non-infective (Sarcoid, Behcets, Juvenile arthritis, ank spond, idiopathic)
infective (tb, HZ, toxoplasmosis, candidiasis, syphilis, lyme disease)
inflam of medium sized vessels ass with polymyalgia rheumatica
GCA
ocular features of thyroid eye disease
ant segment - chemosis, injection, exposure, glaucoma
post segment - choroidal folds, optic nerve swelling
multisystem immunological disease, anti DNA Ig, ocular inflam =
SLE
RA can cause these 3 ocular problems
keratoconjunctivitis sicca, scleritis, corneal melt
triad of Sjogren’s
keratoconjunctivitis sicca
xerostomia
RA
Sjogrens can cause infiltration of ___
lacrimal glands
eye problems associated with Marfan’s (4)
dislocated lens
retinal detachment
myopia
pre-senile cataracts
erythema multiforme, symblepharon, occlusion of lacrimal glands and corneal ulcers are all features of
Stevens-Johnson syndrome
symblepharon =
adhesion of palpebral to bulbar conjunctiva
lesion in left optic nerve causes what visual field defect
left monocular vision loss
lesion in optic chiasm causes what visual field defects
bitemporal hemianopia
lesion in left optic tract causes what visual field defect
right homonomous hemianopia
lesion in left temporal lobe optic radiation causes what visual field defect
right homonomous superior quadrantanopia
lesion in left parietal lobe optic radiation causes what visual field defect
right homonomous inferior quadrantanopia
lesion in left occipital cortex visual area causes what visual field defect
right homonomous hemianopia with macular sparing
why is the macula spared in occipital cortex visual area lesions
has a different blood supply
