Systemic diseases Flashcards
How can diabetes effect the eye?
- diabetic retinopathy
- cataract
- glaucoma (due to new vasculature blocking the drainage)
- ocular nerve palsies
What are the stages of diabetic retinopathy?
mild pre-proliferative: microaneurysms
moderate pre-proliferative: microaneurysms, cotton wool spots, hard exudates, blot haemorrhages, venous beading
severe pre-proliferative: aneurysms and haemorrhage in all quadrants and venous beading in 2
proliferative: neovascularisation
What are the symptoms of diabetic retinopathy?
Central vision loss and painless black floaters
What is diabetic maculopathy?
breakdown of blood-retinal barrier leads to macula oedema
How is diabetic retinopathy managed?
- good glycaemic control
- laser therapy to stop new vessel growth
- intravitreal steroids
What are the complications of diabetic retinopathy?
vitreous haemorrhage and retinal detachment
How does temporal arteritis affect the eye?
inflammation of the ciliary arteries leads to thrombosis and nerve head infarction (optic neuropathy)
The use of topical corticosteroid drops can lead to what?
cataracts
glaucoma
increased risk of infection
What can cause papilledema?
- idiopathic intracranial hypertension
- malignant hypertension
- hydrocephalus
- hypercapnia
- SOL
Describe the appearance of papilledema on fundoscopy
- blurring of the optic disc margins
- venous engorgement
- loss of venous pulsation
- loss of optic cup
vasculidities such as Behcets can affect the branches of the retinal artery, how would this present?
- painless loss/ blurring of vision
- floaters
- scotomas
What is optic neuritis? What can cause it?
inflammation of the the optic nerve
- MS
- diabetes
- syphilis
- autoimmune conditions (Behcets, SLE)
- giant cell arteritis
What are the symptoms of optic neuritis?
- red desaturation
- painful eye movements
- reduced visual acuity
+/- central scotoma
What examination finding is seen in optic neuritis?
RAPD
What is neuroretinitis and what is seen on fundoscopy?
Form of optic neuritis that affects the retina and disc too.
A macula star is seen on fundoscopy
What are the causes of amaurosis fugax and what is the pathophysiology?
- emboli from AF
- atheroma of internal carotid
- emboli from carotid or ophthalmic
- vasculitis
- vasospasm (often exercise induced)
Decrease in ophthalmic, retinal or ciliary blood flow leads to reduced retinal circulation and retinal hypoxia
How do patients describe amaurosis fugax?
a painless black curtain coming over their vision that lasts seconds to minutes
What is Horner’s syndrome and what are the signs and symptoms?
Loss of sympathetic innervation to the eye
- Partial ptosis
- miosis
- Anhidrosis (not in post-ganglionic causes)
What are the causes of Horner’s syndrome?
pre-ganglionic: cervical rib, pancoasts tumour, thyroid surgery, thymoma
central: MS, lateral medullary syndrome (Wallenberg), syrinx
post-ganglionic: cluster headaches, internal carotid artery aneurysm, cavernous sinus thrombosis
Describe the cocaine test for Horner’s syndrome and results
4% cocaine drops applied to the eye should dilate the pupil however in Horner’s it won’t
What causes thyroid eye disease and what is the pathophysiology?
Graves disease
There is expansion of extra-ocular muscle and orbital fat
What are the signs and symptoms of thyroid eye disease?
- proptosis
- lid retraction
- orbital fat prolapse
- optic neuropathy if compressed/ stretched
- ophthalmoplegia (inf. rectus first)
- red, achy eye
- exposure keratopathy
Describe the ocular manifestations of herpes simplex (signs and symptoms)
- red, painful eye
- reduced vision
- FB sensation
- dendritic ulcers with terminal bulbs
What is varicella zoster ophthalmicus?
Reactivation of the VZ virus in V1 (ophthalmic division of trigeminal)
What are the signs and symptoms of VZ ophthalmicus?
- red, painful eye
- Hutchinson’s sign (rash on tip of nose indicated nasociliary involvement and likely ocular manifestation)
- vesicular rash around the eye
- tingling sensation may precede the rash
- pseudodendrites
How is VZ ophthalmicus managed?
Oral or IV aciclovir
What is optic neuropathy/ atrophy?
End stage of damage to the optic nerve in which there is loss of nerve fibres within the optic nerve
What examination findings are seen in optic neuropathy/ atrophy?
- RAPD
- loss of vision
- pale, well demarcated disc with few vessels crossing it’s surface
What can cause optic neuropathy/ atrophy?
- MS
- raised IOP in glaucoma
- longstanding papilledema
- arteritic ischaemia
- retinal vein and artery occlusion
What are the stages of hypertensive retinopathy?
- narrow tortuous arteries and silver wiring
- AV nipping
- cotton wool spots, haemorrhages
- papilledema
What is arteriovenous nipping?
bulging of the vein on either side of an artery that crosses it
What are cotton wool spots?
axonal debris due to nerve fibre infarcts
What are hard exudates?
proteins and lipids that leak out
