Systemic Disease in the eye Flashcards
In a fundoscopy what would someone with poorly controlled diabetes have?
Microaneurysms Hard Exudate Haemorrhage Cotton wool Patches Swollen optic disc
What is the driving force behind an increased production of VEGF?
Ischaemia
New vessel growth occuring here has the worst prognosis for vision loss.
Optic disc
What is Rubeosis Iridis?
New vessel growth over the iris.
Endstage disease involving VEGF
What is seen in the eye of someone with uncontrolled hypertension?
Cotton wool exudates
Disk Swelling - loss of the margin
Thining of blood vessel
Haemorrhage
What does the cornea of someone with Sarcoidosis look like?
Granulomatous Uveitis
Patchy white spots on the underside of the cornea
How does Giant Cell Arteritis present?
Headache
Jaw Claudification
Malaise
Visual Distrubances
What disease is GCA associated with?
Polymyalgia Rheumatica
How does thyroid eye disease present extraocularly?
Proptosis
Lids -Retraction Oedema Lag
Restrictive Myopathy - eye moves slower
How does thyroid eye disease present in the eye?
Chemosis Glaucoma Exposure abrasions Choroidal folds Optic nerve swelling
What is the treatment for thyroid eye disease?
Control thyroid dysfunction
Surgical decompression
Lubricants
What antibody is related to SLE ?
Anti DNA Ab
How does SLE present in the eye?
Scleritis
Painful to move
How does rheumatoid arthritis present in the eye?
Dry eyes
Scleritis
Corneal melting
What is the classic triad of Sjogrens?
Dry eye
Dry mouth
Rheumatoid Arthitis
Why does someone with Sjogrens present with a dry eye?
The lacrimal gland is affected
How do people with Marfans present?
Superiorly dislocated Lens
High Arched Palate
Tall
How does erythema multiform present?
Maculopapular Rash Stomatitis Conjunctivitis Scarring of the conjunctiva Occlusion of the lacrimal duct.
How is erythema multiform triggered?
Food Drug or post infection hypersensitivity reaction.
What nerve innervates the lateral rectus?
Cranial Nerve 6
Abducens
If someone has a CN VI palsy how do they present?
Eye sits more medially
Horizontal diplopia
List some causes of a CN VI palsy.
Microvascular Raised ICP Tumour Congenital Demyelination- MS
If this presents alongside a CN VI palsy what happens?
Papilloedema
If present its a medical emergency.
What cranial nerve supplies the Superior Oblique?
CN IV
Trochlear
Why is the trochlear nerve particularly susceptible to closed ear trauma?
As it originates from the back of the brain and has to work its way around to the front this long route is particularly susceptible to compression damage.
How does someone with a CN IV nerve palsy present?
Vertical diplopia
Depression in adduction
Look for classic head tilt
List some common causes of a CN IV nerve palsy.
Congenital weak SO
Microvascular
Tumour
Closed head trauma
What does CN III supply?
Levator Palpebrae Superiosis Sphincter Pupilla Medial rectus Superior rectus Inferior Rectus Inferior oblique
How does someone with a CN III palsy present?
Only get Adduction and depression from SO and LR
What is general rule with a suspected CN III palsy?
Suspect aneurysm till proven otherwise
If someone with a CN III palsy presents with a dilated pupil what does this mean?
Compression pathology e.g. aneurysm
If the CN III palsy is due to microvascular pathology what is likely to be seen?
No pupil involvement
What is involved in inter nuclear ophthalmoplegia?
A coordination issue, communication between each eye is faulty.
Eyes don’t work in symmetry
What is involved in supra nuclear ophthalmoplegia ?
A coordination issue, this time between the eyes and the rest of the brain.
Balance issues etc
