The Eye in Systemic Disease

Question 1

what is the pathogenesis of diabetic retinopathy?

Answer 1

• chronic hyperglycaemia
• glycosylation of basement membrane
• loss of pericytes
• microaneurysm

Question 2

in what ways can a microaneurysm cause problems?

Answer 2

leakage and ischaemia

Question 3

signs of non-proliferative retinopathy?

Answer 3

• microaneurysms (dot + blot haemorrhages)
• hard exudates
• cotton wool patches
• abnormalities of venous calibre
• intra-retinal microvascular abnormalities

Question 4

where can new vessels grow in diabetic retinopathy?

Answer 4

• grow in disc
• grow in the periphery
• grow on iris if ischaemia is severe

Question 5

what is rebeosis iridis?

Answer 5

new blood vessels forming on the iris

Question 6

in what 3 ways can diabetic patients lose vision?

Answer 6

• retinal oedema affecting the fovea
• vitreous haemorrhage
• scarring/ tractional retinal detachment

Question 7

what are the 5 classifications of retinopathy?

Answer 7

• no retinopathy
• mild
• moderate
• severe
• proliferative retinopathy

Question 8

what are the 4 classifications of maculopathy?

Answer 8

• no maculopathy
• observable maculopathy
• referable maculopathy
• clinically significant maculopathy

Question 9

what surgery can be performed to control growth of new vessels in diabetic retinopathy?

Answer 9

vitrectomy

Question 10

features of hypertensive retinopathy?

Answer 10

• attenuated blood vessels
• cotton wool spots
• hard exudates
• retinal haemorrhages
• optic disc oedema

Question 11

what can happen around the macula which indicates accelerated hypertension?

Answer 11

macular star, hard exudates heading out from macula

Question 12

in what age group does accelerated hypertension tend to affect?

Answer 12

young patients

Question 13

how does a CRAO present?

Answer 13

sudden painless loss of vision

Question 14

how much is vision affected in CRAO?

Answer 14

very profound loss of vision

Question 15

what area of the retina does the retinal nerve fibre layer not become swollen and what sign does this give rise to?

Answer 15

not swollen at fovea, this gives rise to the cherry red spot

Question 16

how does the retina appear in a CRAO?

Answer 16

retina is pale, blood vessels are broken up, cherry red spot

Question 17

how does the retina appear in a CRVO?

Answer 17

blot haemorrhages, hard exudates, retina is darker than normal

Question 18

extraocular features of thryoid eye disease?

Answer 18

• proptosis
• lid signs- retraction, oedema, lag
• restrictive myopathy

Question 19

ocular signs of thryoid eye disease in anterior segment?

Answer 19

• chemosis
• injection
• exposure
• glaucoma

Question 20

ocular signs of thryoid eye disease in posterior segment?

Answer 20

• choroidal folds

- optic nerve swelling

Question 21

what is the most common cause of unilateral and bilateral proptosis?

Answer 21

autoimmune thyroid disease

Question 22

how is thyroid eye disease managed?

Answer 22

• control of thyroid dysfunction
• lubricants
• surgical decompression

Question 23

if someone has thyroid disease, what puts them at a much higher risk of developing thyroid eye disease?

Answer 23

smoking

Question 24

what can RA cause in the eye?

Answer 24

• dry eyes
• scleritits
• corneal melt

Question 25

what is the triad of Sjogrens syndrome?

Answer 25

• dry eye
• dry mouth
• RA

Question 26

what part of the eye does Sjorgens affect?

Answer 26

lacrimal glands

Question 27

in what direction does the lens dislocate in Marfans?

Answer 27

upwards

Question 28

how does a dislocated lens present and how is it managed?

Answer 28

sudden profound loss of vision, corrected surgically

Question 29

what are the features of Stevens-Johnson syndrome in the eyes?

Answer 29

Symblepharon
occlusion of lacrimal glands
corneal ulcers

Question 30

what is symblepharon and what does it lead to?

Answer 30

sticking together of the fornice, causes tight band of scaring