Systemic eye disease Flashcards

1
Q

What is thyroid eye disease

A

Autoimmune disease caused by activation of orbital fibroblasts by autoantibodies directed against thyroid receptors

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2
Q

Thyroid eye disease is mostly associated with

A

Grave’s

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3
Q

90% of thyroid eye disease is associated with Grave’s. How about the rest of the 10%

A

Normal functioning thyroid
Hashimoto’s

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4
Q

What are the effects on the eye due to TSH receptor autoantibodies in thyroid eye disease

A

Extraocular muscle enlargement
Orbital fat expansion

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5
Q

Describe the stages of thyroid eye disease

A
  1. Soft tissue involvement
  2. Lid retraction
  3. Proptosis
  4. Optic neuropathy
  5. Restrictive myopathy
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6
Q

Risk factors for development of thyroid eye disease

A

Smoking
Radioiodine treatment - increases the inflammatory symptoms in thyroid eye disease

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7
Q

Symptoms of thyroid eye disease

A

Periorbital swelling
Exophthalmos (proptosis)
Unable to close eyelids -> dry eyes, exposure keratopathy
Ophthalmoplegia (weakness of eye muscles) -> double / blurred vision

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8
Q

Unable to close eyelids can lead to

A

Dry, sore eyes
Exposure keratitis

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9
Q

What ophthalmological feature does dermatomyositis cause

A

Heliotrope rash on eyelids

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10
Q

Dermatomyositis is a ______ phenomenon hence ______ after diagnosis

A

Dermatomyositis is a paraneoplastic phenomenon (i.e. it is associated with malignancies - breast, lungs, ovarian) hence patients need to undergo CT chest, abdomen and pelvis after diagnosis

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11
Q

What ophthalmological conditions can Marfan syndrome cause

A

Dislocated lens
Blue sclera
Myopia

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12
Q

Which type of dislocated lens does Marfan syndrome cause

A

Superotemporal dislocation

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13
Q

What are the types of diabetic retinopathy

A

Non-proliferative
Proliferative
Macular edema

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14
Q

Pathophysiology of diabetic retinopathy

A
  1. Hyperglycaemia causes increased retinal blood flow and abnormal metabolism of glucose in retinal vessel walls
  2. This causes damage to endothelial cells and pericytes
  3. endothelial dysfunction -> increased permeability -> lipids, proteins leak out -> exudates
  4. Necrosis of the vessel wall triggers release of vascular endothelial growth factor
  5. this causes formation of new, fragile vessels which can rupture and cause visual loss
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15
Q

What is non-proliferative retinopathy

A

Early stage of diabetic retinopathy where blood vessels are weakened but have not yet formed new blood vessels

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16
Q

What is proliferative retinopathy

A

Late stage of diabetic retinopathy where new fragile blood vessels have formed

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17
Q

Weakened vessels in non-proliferative retinopathy leads to the formation of

A

microaneurysms

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18
Q

What is considered as mild NPDR

A

1 or more microaneurysm

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19
Q

What is considered as moderate NPDR

A

Microaneurysms
Blot haemorrhage
Hard exudates
Cotton wool spots

20
Q

What are cotton wool spots

A

Soft exudates which represent areas of retinal infarction

21
Q

What is considered as severe NPDR

A

Blot haemorrhages and micro aneurysms in 4 quadrants
Venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

4-2-1 rule

22
Q

What is venous beading

A

tortuosity and beading (irregular constriction and dilation) of the retinal veins

23
Q

What is IRMA

A

abnormal branching / dilation of existing retinal vessels

24
Q

What are the features of proliferative diabetic retinopathy

A

Retinal neovascularisation
Fibrous tissue forming anterior to retinal disc
Vitreous haemorrhage

25
Symptom of vitreous haemorrhage
Sudden painless loss of vision Floaters / dark spots in vision Red hue in vision
26
Which type of diabetes is more likely to have proliferative diabetic retinopathy
type 1
27
What is the macula
Area in the center of retina which is responsible for the high acuity central colour vision
28
Signs of macular oedema in diabetic retinopathy
Hard exudates Oedematous changes in or around the macula Reduced visual acuity
29
Macular oedema is more common which type of diabetics
Type 2
30
General management of diabetic retinopathy
Optimise glycemic control, blood pressure Regular review
31
Management of non-proliferative diabetic retinopathy
Regular observation Panretinal laser photocoagulation for severe / very severe NPDR
32
Management for proliferative diabetic retinopathy
Panretinal laser photocoagulation Intravitreal VEGF inhibitors Vitreoretinal surgery
33
Function of intravitreal VEGF inhibitors
Blocks angiogenesis and decrease vascular permeability
34
Examples of VEGF inhibitors
Ranibizumab Aflibercept
35
Management of macular oedema in diabetic retinopathy
intravitreal VEGF inhibitors Vitreal surgery
36
What ophthalmological conditions can steroids lead to
Glaucoma Cataracts
37
The effect of steroids on intraocular pressure
Increases the intraocular pressure
38
What is neurofibromatosis type 1
Genetic condition that causes tumours along the nervous system
39
Inheritance pattern of neurofibromatosis type 1
Autosomal dominant
40
Neurofibromatosis type 1 is due to mutation in
Chromosome 17
41
What are the features of neurofibromatosis type 1
Cafe-au-lair spots >/ 6 Axillary / groin freckles Peripheral neurofibromas Lisch nodules in the eyes Optic glioma Scoliosis Phaeochromocytoma
42
What are the eye involvements in neurofibromatosis type 1
Lisch nodules Optic glioma
43
What is optic glioma
Slow growing tumour of the optic nerve causing globe proptosis and worsening of vision
44
What are Lisch nodules
yellow / brown dome-shaped nodules
45
Which ocular involvement of NF1 is more common
Lisch nodules