the eye and systemic disease Flashcards
what is thyroid eye disease
Autoimmune disease caused by the activation of orbital fibroblasts by autoantibodies directed against thyroid receptors
what is the most common association with thyroid eye disease
graves disease
what characterises thyroid eye disease
enlargement of the extraocular muscles, fatty and connective tissue volume
state the 5 main stages of thyroid eye disease
- soft tissue involvement
- lid retraction
- proptosis
- optic neuropathy
- restrictive myopathy
complication of proptosis in thyroid eye disease
exposure keratopathy leading to corneal ulceration
what is the most common cause of proptosis
thyroid eye disease
management of thyroid eye disease
steroids
lubricant
stop smoking !!
what is vortex keratopathy
deposition of medications in the corneal epithelium
drug most associated with vortex keratopathy
amiodarone
drug most associated with bullseye maculopathy
chloroquine
consequence of steroids on the eye
increased intraocular pressure
what is Symblepharon
adhesions or fusions between the conjunctiva and the cornea
name a drug associated with symblepharon
penicillin
what does the 3rd cranial nerve supply in the eye (6)
medial rectus
inferior rectus
superior rectus
inferior oblique
sphincter pupillae
levator palpebrae superioris
clinical sign of 3rd nerve palsy
eye down and out
may also cause ptosis and miosis
what causes ptosis in 3rd nerve palsy
lack of innervation to levator palpebrae superioris
what causes miosis in 3rd nerve palsy
loss of parasympathetic innervation to the sphincter pupillae muscle
what does painful 3rd nerve palsy indicate
aneurysm
what can cause bilateral 4th nerve palsy
closed head trauma
what does cranial nerve 4 supply in the eye
superior oblique muscle
clinical presentation of 4th nerve palsy
affected eye turned upward in primary position
vertical diplopia when looking inferiorly
what is the most common acute nerve palsy
6th cranial nervee
what does the 6th cranial nerve supply in the eye
lateral rectus muscle
clinical presentation of 6th nerve palsy
horizontal diplopia worsened when looking towards the affected side
state the main cause of 6th nerve palsy
raised intercranial pressure
state the 2 main causes of 4th nerve palsy
congenital, trauma
name 4 causes of visual field defects
vascular disease, space occupying lesion, demyelination, trauma
causes of optic nerve defect (3)
ischaemic optic neuropathy
optic neuritis - MS
tumours - meningioma, glioma, haemangioma
clinical presentation of an optic nerve defect
unilateral visual loss
name some causes of an optic chiasm defect (3)
pituitary tumour, craniopharyngioma, meningioma
field defect seen in obstruction to the optic chiasm
bitemporal field defect
state 3 causes of optic tract and radiation defects
tumours, demyelination and vascular anomalies
visual field defect seen in obstruction to the optic tracts
contralateral homonymous hemianopia
visual field defect seen in obstruction to the optic radiations
contralateral homonymous quadrantopia
is the macula spared in defects involving the optic tracts and radiations
no
name 2 causes of field defects associated with the optic cortex
vascular disease, demyelination
field defect seen in damage to the optic cortex
contralateral homonymous hemianopia with macular sparing
scanning used to investigate visual field defects
MRI
what is myotonia
inability to relax after muscle contraction
mutation associated with myotonic dystrophy type 1
AD mutation in dystrophia myotonica protein kinase gene DMPK
mutation associated with type 2 myotonic dystrophy
abnormally expanded section in ZNF9 gene
clinical presentation of myotonic dystrophy (4)
muscle wasting and weakness
mournful facial expression
slurred speech
frontal baldness in males
name 3 common ocular manifestations of myotonic dystrophy
early onset cataract, ptosis, hypermetrophia
cataract associated with myotonic dystrophy
stellate posterior cortical cataract
name 4 uncommon ocular manifestations of myotonic dystrophy
mild ophthalmoplegia
pupillary light-near dissociation
pigmentary retinopathy
optic atrophy
2 ocular features of neurofibromatosis type 1
optic glioma
lisch nodules
clinical presentation of an optic glioma
globe proptosis and afferent pupillary defect
what are lisch nodules
bilateral yellow or brown dome-shaped nodules
what is dermatomyositis
an autoimmune condition that causes skin changes and muscle weakness
name a drug that can cause dermatomyositis
hydroxyurea
main ocular feature of dermatomyositis
heliotrope rash on eyelids
inheritance seen in marfans syndrome
autosomal dominant mutation of the fibrillin-1 gene
what is the main ocular feature of marfans syndrome
dislocated lens
name some non-ocular features of marfans
tall, thin stature
arachnodactyly
narrow high-arched palate
pectus excavatum
dilated aortic root
name 2 ocular features of rheumatoid arthritis
scleromalacia perforans
peripheral ulcerative keratitis
ocular feature of sjorgrens syndrome
punctuate epithelia erosions seen using fluorescein
state 3 conditions in which granulomatous anterior uveitis is seen
sarcoidosis
TB
syphillis
state 2 conditions in which we see posterior synechiae
HLA B27 and idiopathic anterior uveitis
what are the 2 main classifications of diabetic retinopathy
proliferative and non-proliferative
clinical presentation of non-proliferative diabetic retinopathy (4)
- microaneurysms
- hard exudates
- intraretinal haemorrhages
- cotton wool spots - caused by ischaemia
clinical presentation of proliferative diabetic retinopathy (2)
neovascularisation
vitreous haemorrhage and traction
name another eye complication of diabetes
diabetic macular oedema
management of macular oedema
anti-VGEF
laser therapy for clinically significant oedema
vitrectomy used when signs of traction
management of proliferative diabetic retinopathy
panretinal photocoagulation
