The Eye in Systemic Disease

Question 1

What ocular finding is pathognomonic of myotonic dystrophy*?

*(delayed muscle relaxation on stopping voluntary action)

Answer 1

Stellate posterior cortical cataract (looks like a snowflake on the retina)

Question 2

What 2 ocular findings are pathognomonic of neurofibromatosis?

Answer 2

Lisch nodules (small yellow or brown dots in the eyes)

Optic glioma (globe enlargement and proptosis, not as common)

Question 3

What ocular finding is pathognomonic of thyroid eye disease?

Answer 3

Proptosis

Question 4

What ocular finding is pathognomonic of dermatomyositis?

Answer 4

Peri-orbital heliotrope rash (lilac coloured swelling)

Question 5

What ocular finding is pathognomonic of Marfan’s syndrome?

Answer 5

Dislocated lens (classically superotemporal dislocation, zonules are still intact)

Question 6

What ocular finding is pathognomonic of rheumatoid arthritis?

Answer 6

Thinning of the cornea leading to…

• Exposure of underlying uveal tissue (scleromalacia perforans)
• Conjunctival vessel dilation starting at the periphery and moving in (peripheral ulcerative keratitis)

Question 7

What ocular finding is pathognomonic of Sjogren’s syndrome?

Answer 7

Punctuate epithelial erosions (small dotted erosions)

Question 8

What do ‘mutton fat’ keratic precipitates look like?

What do they signify?

Answer 8

Tiny fat globules under the surface of the cornea

They signify granulomatous anterior uveitis

Question 9

What sort of pathologies cause keratic precipitates?

Answer 9

Granulomatous pathologies

e.g., sarcoidosis, TB, syphilis

Question 10

What is posterior synechiae?

Answer 10

When the iris adheres to the anterior lens due to inflammation
(makes the pupil look irregular)

Question 11

What sort of pathologies cause posterior synechiae?

Answer 11

HLA B27 associated conditions (usually CTDs)

Idiopathic anterior uveitis

Question 12

Name 3 conditions which can cause posterior uveitis?

Answer 12

Retinitis
Vasculitis
Optic neuritis

Question 13

Name 3 drugs which can cause vortex keratopathy

whorl-like pattern of epithelial deposits in the cornea

Answer 13

Amiodarone
Hydroxychloroquine
Chlorpromazine

Question 14

Name 2 drugs which can cause bulls eye maculopathy

pale ring seen around the macula

Answer 14

Hydroxychloroquine

Chloroquine

Question 15

Name 2 drugs which can cause symblepharon

abnormal conjunctival adhesions

Answer 15

Sulfa drugs

Penicillins

Question 16

Ocular pathology can also be caused by steroid response. Name 2 possible ocular side effects of steroids

Answer 16

Cataract (most common)

Increased intra-ocular pressure

Question 17

List these steroid routes in order of which is most likely to cause ocular pathology

• Oral
• Inhaled
• Topical drops

Answer 17

Topical drops > oral > inhaled

Question 18

Steroid response is most common in which 2 patient groups?

Answer 18

Children

Glaucoma patients