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ophthalmology > the eye and systemic disease > Flashcards

the eye and systemic disease Flashcards

1
Q

what is thyroid eye disease

A

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

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1
Q

what is the most common association with thyroid eye disease

A

graves disease

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1
Q

what characterises thyroid eye disease

A

enlargement of the extraocular muscles, fatty and connective tissue volume

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1
Q

state the 5 main 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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1
Q

complication of proptosis in thyroid eye disease

A

exposure keratopathy leading to corneal ulceration

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1
Q

what is the most common cause of proptosis

A

thyroid eye disease

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2
Q

management of thyroid eye disease

A

steroids
lubricant
stop smoking !!

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3
Q

what is vortex keratopathy

A

deposition of medications in the corneal epithelium

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4
Q

drug most associated with vortex keratopathy

A

amiodarone

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5
Q

drug most associated with bullseye maculopathy

A

chloroquine

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6
Q

consequence of steroids on the eye

A

increased intraocular pressure

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7
Q

what is Symblepharon

A

adhesions or fusions between the conjunctiva and the cornea

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8
Q

name a drug associated with symblepharon

A

penicillin

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9
Q

what does the 3rd cranial nerve supply in the eye (6)

A

medial rectus
inferior rectus
superior rectus
inferior oblique
sphincter pupillae
levator palpebrae superioris

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10
Q

clinical sign of 3rd nerve palsy

A

eye down and out
may also cause ptosis and miosis

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11
Q

what causes ptosis in 3rd nerve palsy

A

lack of innervation to levator palpebrae superioris

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12
Q

what causes miosis in 3rd nerve palsy

A

loss of parasympathetic innervation to the sphincter pupillae muscle

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13
Q

what does painful 3rd nerve palsy indicate

A

aneurysm

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14
Q

what can cause bilateral 4th nerve palsy

A

closed head trauma

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15
Q

what does cranial nerve 4 supply in the eye

A

superior oblique muscle

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16
Q

clinical presentation of 4th nerve palsy

A

affected eye turned upward in primary position
vertical diplopia when looking inferiorly

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17
Q

what is the most common acute nerve palsy

A

6th cranial nervee

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18
Q

what does the 6th cranial nerve supply in the eye

A

lateral rectus muscle

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19
Q

clinical presentation of 6th nerve palsy

A

horizontal diplopia worsened when looking towards the affected side

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20
Q

state the main cause of 6th nerve palsy

A

raised intercranial pressure

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21
Q

state the 2 main causes of 4th nerve palsy

A

congenital, trauma

22
Q

name 4 causes of visual field defects

A

vascular disease, space occupying lesion, demyelination, trauma

23
Q

causes of optic nerve defect (3)

A

ischaemic optic neuropathy
optic neuritis - MS
tumours - meningioma, glioma, haemangioma

24
Q

clinical presentation of an optic nerve defect

A

unilateral visual loss

25
Q

name some causes of an optic chiasm defect (3)

A

pituitary tumour, craniopharyngioma, meningioma

26
Q

field defect seen in obstruction to the optic chiasm

A

bitemporal field defect

27
Q

state 3 causes of optic tract and radiation defects

A

tumours, demyelination and vascular anomalies

28
Q

visual field defect seen in obstruction to the optic tracts

A

contralateral homonymous hemianopia

29
Q

visual field defect seen in obstruction to the optic radiations

A

contralateral homonymous quadrantopia

30
Q

is the macula spared in defects involving the optic tracts and radiations

A

no

31
Q

name 2 causes of field defects associated with the optic cortex

A

vascular disease, demyelination

32
Q

field defect seen in damage to the optic cortex

A

contralateral homonymous hemianopia with macular sparing

33
Q

scanning used to investigate visual field defects

A

MRI

34
Q

what is myotonia

A

inability to relax after muscle contraction

35
Q

mutation associated with myotonic dystrophy type 1

A

AD mutation in dystrophia myotonica protein kinase gene DMPK

36
Q

mutation associated with type 2 myotonic dystrophy

A

abnormally expanded section in ZNF9 gene

37
Q

clinical presentation of myotonic dystrophy (4)

A

muscle wasting and weakness
mournful facial expression
slurred speech
frontal baldness in males

38
Q

name 3 common ocular manifestations of myotonic dystrophy

A

early onset cataract, ptosis, hypermetrophia

39
Q

cataract associated with myotonic dystrophy

A

stellate posterior cortical cataract

40
Q

name 4 uncommon ocular manifestations of myotonic dystrophy

A

mild ophthalmoplegia
pupillary light-near dissociation
pigmentary retinopathy
optic atrophy

41
Q

2 ocular features of neurofibromatosis type 1

A

optic glioma
lisch nodules

42
Q

clinical presentation of an optic glioma

A

globe proptosis and afferent pupillary defect

43
Q

what are lisch nodules

A

bilateral yellow or brown dome-shaped nodules

44
Q

what is dermatomyositis

A

an autoimmune condition that causes skin changes and muscle weakness

45
Q

name a drug that can cause dermatomyositis

A

hydroxyurea

46
Q

main ocular feature of dermatomyositis

A

heliotrope rash on eyelids

47
Q

inheritance seen in marfans syndrome

A

autosomal dominant mutation of the fibrillin-1 gene

48
Q

what is the main ocular feature of marfans syndrome

A

dislocated lens

49
Q

name some non-ocular features of marfans

A

tall, thin stature
arachnodactyly
narrow high-arched palate
pectus excavatum
dilated aortic root

50
Q

name 2 ocular features of rheumatoid arthritis

A

scleromalacia perforans
peripheral ulcerative keratitis

51
Q

ocular feature of sjorgrens syndrome

A

punctuate epithelia erosions seen using fluorescein

52
Q

state 3 conditions in which granulomatous anterior uveitis is seen

A

sarcoidosis
TB
syphillis

53
Q

state 2 conditions in which we see posterior synechiae

A

HLA B27 and idiopathic anterior uveitis

54
Q

what are the 2 main classifications of diabetic retinopathy

A

proliferative and non-proliferative

55
Q

clinical presentation of non-proliferative diabetic retinopathy (4)

A
  • microaneurysms
  • hard exudates
  • intraretinal haemorrhages
  • cotton wool spots - caused by ischaemia
56
Q

clinical presentation of proliferative diabetic retinopathy (2)

A

neovascularisation
vitreous haemorrhage and traction

57
Q

name another eye complication of diabetes

A

diabetic macular oedema

58
Q

management of macular oedema

A

anti-VGEF
laser therapy for clinically significant oedema
vitrectomy used when signs of traction

59
Q

management of proliferative diabetic retinopathy

A

panretinal photocoagulation

ophthalmology (10 decks)

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