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Ophthalmology for Finals > Systemic diseases > Flashcards

Systemic diseases Flashcards

1
Q

How can diabetes effect the eye?

A
  • diabetic retinopathy
  • cataract
  • glaucoma (due to new vasculature blocking the drainage)
  • ocular nerve palsies
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2
Q

What are the stages of diabetic retinopathy?

A

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

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3
Q

What are the symptoms of diabetic retinopathy?

A

Central vision loss and painless black floaters

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4
Q

What is diabetic maculopathy?

A

breakdown of blood-retinal barrier leads to macula oedema

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5
Q

How is diabetic retinopathy managed?

A
  • good glycaemic control
  • laser therapy to stop new vessel growth
  • intravitreal steroids
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6
Q

What are the complications of diabetic retinopathy?

A

vitreous haemorrhage and retinal detachment

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7
Q

How does temporal arteritis affect the eye?

A

inflammation of the ciliary arteries leads to thrombosis and nerve head infarction (optic neuropathy)

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8
Q

The use of topical corticosteroid drops can lead to what?

A

cataracts
glaucoma
increased risk of infection

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9
Q

What can cause papilledema?

A
  • idiopathic intracranial hypertension
  • malignant hypertension
  • hydrocephalus
  • hypercapnia
  • SOL
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10
Q

Describe the appearance of papilledema on fundoscopy

A
  • blurring of the optic disc margins
  • venous engorgement
  • loss of venous pulsation
  • loss of optic cup
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11
Q

vasculidities such as Behcets can affect the branches of the retinal artery, how would this present?

A
  • painless loss/ blurring of vision
  • floaters
  • scotomas
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12
Q

What is optic neuritis? What can cause it?

A

inflammation of the the optic nerve

  • MS
  • diabetes
  • syphilis
  • autoimmune conditions (Behcets, SLE)
  • giant cell arteritis
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13
Q

What are the symptoms of optic neuritis?

A
  • red desaturation
  • painful eye movements
  • reduced visual acuity

+/- central scotoma

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14
Q

What examination finding is seen in optic neuritis?

A

RAPD

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15
Q

What is neuroretinitis and what is seen on fundoscopy?

A

Form of optic neuritis that affects the retina and disc too.
A macula star is seen on fundoscopy

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16
Q

What are the causes of amaurosis fugax and what is the pathophysiology?

A
  • 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

17
Q

How do patients describe amaurosis fugax?

A

a painless black curtain coming over their vision that lasts seconds to minutes

18
Q

What is Horner’s syndrome and what are the signs and symptoms?

A

Loss of sympathetic innervation to the eye

  • Partial ptosis
  • miosis
  • Anhidrosis (not in post-ganglionic causes)
19
Q

What are the causes of Horner’s syndrome?

A

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

20
Q

Describe the cocaine test for Horner’s syndrome and results

A

4% cocaine drops applied to the eye should dilate the pupil however in Horner’s it won’t

21
Q

What causes thyroid eye disease and what is the pathophysiology?

A

Graves disease

There is expansion of extra-ocular muscle and orbital fat

22
Q

What are the signs and symptoms of thyroid eye disease?

A
  • proptosis
  • lid retraction
  • orbital fat prolapse
  • optic neuropathy if compressed/ stretched
  • ophthalmoplegia (inf. rectus first)
  • red, achy eye
  • exposure keratopathy
23
Q

Describe the ocular manifestations of herpes simplex (signs and symptoms)

A
  • red, painful eye
  • reduced vision
  • FB sensation
  • dendritic ulcers with terminal bulbs
24
Q

What is varicella zoster ophthalmicus?

A

Reactivation of the VZ virus in V1 (ophthalmic division of trigeminal)

25
Q

What are the signs and symptoms of VZ ophthalmicus?

A
  • 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
26
Q

How is VZ ophthalmicus managed?

A

Oral or IV aciclovir

27
Q

What is optic neuropathy/ atrophy?

A

End stage of damage to the optic nerve in which there is loss of nerve fibres within the optic nerve

28
Q

What examination findings are seen in optic neuropathy/ atrophy?

A
  • RAPD
  • loss of vision
  • pale, well demarcated disc with few vessels crossing it’s surface
29
Q

What can cause optic neuropathy/ atrophy?

A
  • MS
  • raised IOP in glaucoma
  • longstanding papilledema
  • arteritic ischaemia
  • retinal vein and artery occlusion
30
Q

What are the stages of hypertensive retinopathy?

A
  1. narrow tortuous arteries and silver wiring
  2. AV nipping
  3. cotton wool spots, haemorrhages
  4. papilledema
31
Q

What is arteriovenous nipping?

A

bulging of the vein on either side of an artery that crosses it

32
Q

What are cotton wool spots?

A

axonal debris due to nerve fibre infarcts

33
Q

What are hard exudates?

A

proteins and lipids that leak out

Ophthalmology for Finals (8 decks)

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