The eye in systemic disease Flashcards
Presentationof CN VI palsy?
Can’t abduct the eye
Causes of CN VI palsy
Microvascular
Raised ICP
Tumour
Congenital
Presentation of CN IV palsy
wEAK DEPRESSION IN ADDUCTION
Clinical features of bilateral IV palsy
ToRsion
Chin depressed
Cause of bilateral CN IV palsy
Blunt head trauma
Causes of CN IV palsy
Congenital decompensated
Microvascular
Tumour
Presentation of CN III palsy
Down & out
Causes of CN III palsy
Microvascular Tumour Aneurysm MS Congenital
What causes a painful CN III palsy?
Aneurysm
Causes of inter-nuclear opthalmoplegia
MS
Vascular
Lots of small print
What is inter-nucleur opthalmoplegia?
When patients eyes are directed away from the side of the lesion the affected eye will not move past the midline and the non-affected eye will have nystagmus
Causes of visual field defect
Vasclar disease
Scape occupying lesion
Demyelination (MS)
Trauma
Who is optic neuritis common in?
MS patients
What tumours can affect the optic nerve?
Meningioma
Glioma
Haemangioma
Presentation of optic neuritis
Progressive visual loss (unilateral)
Pain behind eye, especially on movement
Colour desaturation
Central scotoma
What can cause compression on the optic chiasm?
Pituitary tumour
Craniopharyngioma
Meningioma
What causes bitemporal field defect?
Optic chiasm compression
Is visual loss or disturbance permanent with a pituitary tumour?
It is commonly reversed after the tumour is decompressed or removed
WHat can affect the occipital cortex?
Vascular disease (CVA) Demyelination
Pathogenesis of diabetic retinopathy
Chronic hyperglycaemia
Glycosylation of protein/basement membrane
Loss of pericytes
microanuerysm
Microaneurysm can lead to leakage & ischaemia
Signs of non-proliferative retinopathy on fundoscopy
Microaneurysms/ dot & lot haemorrhages Hard exudate Cotton wool patches Aormalities of venous calibre Intra-retin
In what stages do new vessels grow in diabetic retinopathy?
Grow on disc
Grow in the periphery
Grow on iris if ischaemia is severe
What can cause diabetics to lose vision?
Retinal oedema
Vitreous haemorrhage
Scarring/tractional retinal detachment
How is diabetic retinopathy classified?
Mild
Moderate (non-proliferative retinopathy)
Severe (non-proliferative retinopathy)
Proliferative retinopathy
How is diabetic maculopathy classified?
No maculopathy
Observable maculopathy
Referable maculopathy
Clinically significant maculopathy
Management of diabetic retinopathy
Optimise medical management
Laser
Vitrectomy
Rehabilliatation
Features of hypertensive retinopathy on fundoscopy
Atenuated blood vessels/ copper or silver wiring Cotton wool spots Hard exudates Retinal haemmorhage Optic disc oedema
How does accelerated hypertension tend to present?
Particularly in young patients
Very dramaic fundal appearance
Can have decreased vision
Presentation of central retinal artery occlusion
Sudden painless loss of vision
Very profound loss of vision
Retinal nerve fibre layer becomes swollen except at fovea (cherry red spot)
Presentation of central retinal vein occlusion
Sudden pailess visual loss
range of visual loss
Ischaemia correlates to degree of reduced vision and fundal appearances
How does a branch vein occlusion present?
Painless disturbance in vision
May be assymptomatic
May be aware of loss of part of field
Infective causes of uveitis
TB Herpes Zoster Toxoplasmosis Candidiasis Syphilis Lyme disease
Non-infective causes of uveitis
Idiopathic syndromes HLA-B27 Juvenile Arthritis Sarcoidosis Behcet's disease
Presentation of GCA
PMR Headache Jaw claudication Malaise Raised P.V. Blinding condition
Extraocular features of thyroid eye disease
Proptosis Lid retraction Lid oedema Lid lag Lid pigmentation Restrictive myopathy
What is chemosis?
Oedema of the conjunctiva
Ocular features of thyroid eye disease
Chemosis Injection Exposure Glaucoma Choroidal folds Optic nerve swelling
What is the most common cause of unilateral and bilateral proptosis
Thyroid eye disease
How is thyroid eye disease treated?
Control of thyroid dysfunction
Lubricants
Surgical decompression
Smoking
What efect can SLE have on the eyes?
Ocular inflammation
What effect can RA have on the eyes?
Dry eyes
Scleritis
Corneal melt
What is the triad of Sjogren’s syndrome?
Keratoconjunctivitis sicca
Xerostomia
RA
Ocular features of Steven-Johnson syndrome
Symblepharon
Occlusion of lacrimal glands
Corneal ulcers
