Systemic disorders of the Eye

Question 1

Hypertensive retinopathy components that dictate severity [2]

Answer 1

1. Severity of blood pressure

2. Duration of hypertension

Question 2

Hypertensive retinopathy signs [7]

Answer 2

A-V nipping 
Arteriosclerotic changes 
Arteriolar light reflex changes 
Hard exudates (as macular star) 
Flame haemorrhages 
CWS 
Disc oedema - malignant hypertension

Question 3

Diabetic retinopathy
Pathophysiology
RF [3]

Answer 3

• Microangiopathy with microvascular occlusion & leakage
• Risk factors:
  1. Duration of diabetes
  2. poor metabolic control
  3. pregnancy

Question 4

Diabetic retinopathy [7]

Answer 4

Microaneurysms
Retinal hemorrhages
Exudates
Macular edema
Cotton wool spots
IRMA - intraretinal microvascular abnormality
Abnormal new vessels growth

Question 5

Classification of DR [2]

Answer 5

Proliferative

Non-proliferative

Question 6

Features of:
Background diabetic retinopathy [2]
Pre-poliferative [2]
Proliferative [2]
Diabetic macular edema [3]

Answer 6

Background diabetic retinopathy
- Dot & blot hemorrhage
Pre-poliferative
- Cotton wool spots, IRMA
Proliferative
- New vessels, tractional retinal detachment
Diabetic macular edema
- Exudates, hemorrhage, retinal thickening

Question 7

DR Tx [4]

Answer 7

Control blood sugar, BP, cholesterol
Laser
Surgery - severe cases
Intravitreal anti-VEGF, steroid

Question 8

Thyroid eye disease [7]

Answer 8

Lymphocytic infiltration
Edema
Increased fibroblastic activity in these tissues
Lid retraction, proptosis > corneal exposure
Reduced ocular movement
Diplopia, optic nerve compression
Chemosis
Reduced colour vision, sluggish pupil responses

Question 9

Proptosis in thyroid eye disease
Indicates…
What investigation can visualize this?

Answer 9

Proptosis and infiltration is secondary to the increase in tissue bulk and proliferation of orbital fat. (seen on CT or echography of orbit).

Question 10

Rheumatoid arthritis eye disease [4]
Juvenile RA (Stills) [2]

Answer 10

i) Rheumatoid Arthritis
• Keratoconjunctivitis sicca
• Uveitis (rare)
• Episcleritis
• Scleritis/scleromalacia perforans

ii) Juvenille RA (Stills)
• Oligoarticular (Uveitis)
• ANA + ve (Uveitis)

Question 11

Ankylosing spondylitis eye disease
Reiter’s syndrome triad [3]
Reiter’s syndrome eye disease [2]

Answer 11

• Anterior/posterior uveitis

Reiter’s syndrome:

• conjunctivitis, urethritis, and arthritis
• Conjuncitivitis or iritis

Question 12

Behcet’s disease [4]

Answer 12

• Multisystem vasculitis
• Iritis (hypopyon) - retinal vasculitis
• Mouth/genital ulcers
• Arthropathy skin rash

Question 13

Collagen disorders with ocular presentations:

1. What do you think when these patients present with dry eyes? [2]
2. Scleritis [2]?

Answer 13

1. Dry eye (Rheumatoid arthritis, sarcoid)

2. Scleritis (Rheumatoid arthritis, Wegener’s granulomatosis)

Question 14

What can be associated with retinal vasculitis

Answer 14

SLE

PAN - polyarteritis nodosa

Question 15

Sarcoidosis eye disease [4]

Answer 15

• Iritis/posterior uveitis
• Dry eyes (conjunctival granulomas/lacrimal gland involvement)
• Cranial nerve palsies
• Optic neuropathy