The eye in systemic disease Flashcards
Structural eye changes in DM (2)
accelerated age-related cataracts; lens takes up glucose>sorbitol
rubeosis iridis due to ischaemia blocks ocular drainage>glaucoma
Fundoscopical features of diabetic retinopathy (5)
- vessel proliferation
- cotton wool spots due to nerve ischaemia
- microaneurysms-seen as small dots
- rupture of microaneurysms forming flame (at nerve fibre level) and blot(deep in retina) haemorrhages
- hard exudates formed by lipoprotein/lipid-containing macrophages
pathology of diabetic retinopathy (6)
due to occlusion and leakage of retinal vessels.
occlusion:
- ischaemia>neovascularisation>increased risk of vitreous haemorrhage and retinal detachment
- cotton wool spots due to ischaemic nerve fibres
vascular leakage:
- loss of pericytes>microaneurysms which can rupture to form flame or blot haemorrhages.
- oedema
- hard exudates
screening for diabetic retinopathy
annual screening w. dilated retinal photography to allow early photocoagulation.
Grading severity of diabetic retinopathy
non-proliferative-R0(no retinopathy), R1(background retinopathy), R2(pre-proliferative).
proliferative-R3
maculopathy-M
Features of background retinopathy-R1 (3)
=/>4 microaneurysms
flame/blot haemorrhages
hard exudates
(features from vascular leakage)
Features of pre-proliferative retinopathy-R2 (4)
all features of background retinopathy with features of occlusion:
- cotton wool spots
- vascular changes: engorged, tortuous veins and venous beading/loops or reduplication.
- large, deep, round blot haemorrhages
- intra-retinal microangiopathy (IRMA).
Features of proliferative diabetic retinopathy-R3 (4)
new fine vessels form over retina and optic disc
vitreous haemorrhage can occur
tractional retinal detachment; can be assessed via USS.
pre-retinal fibrosis
Features of maculopathy in DM-M (4)
based on location not severity
leakage of vessels close to macula>oedema
exudate and retinal thickening occur one optic disc’s distance from fovea
sight is threatened.
Conditions that can accelerate diabetic retinopathy (6)
pregnancy anaemia HTN renal disease dyslipidaemia smoking
Rx of diabetic retinopathy (2)
pan-retinal photocoagulation: burn outside of retina destroying hypoxic rods which can produce VEGF. SEs are loss of peripheral vision and night blindness.
for maculopathy: intravitreal triamcinelone+anti-VEGF
Other ocular manifestations of DM (3)
CN palsies esp. III and VI
Horner’s syndrome
Argyll-Robertson pupil
Features of arteriopathic retinopathy
AV nipping: where veins and arteries cross and they share the same connective tissue sheath
Features of hypertensive retinopathy (6)
arterial walls thick and shiny like silver wiring
vasoconstriction and leakage of arterioles:
- hard exudates
- macular oedema
- haemorrhages
- papilloedema-starburst exudates
infarction of superficial retina causing cotton wool spots and flame haemorrhages
Amaurosis fugax features and causes (6)
due to compromised retinal artery
causes:
- emboli most common
- GCA
- orbital schwannomas
- meningiomas
- ocular small vessel disease
Haematological causes of eye disease (3)
leukemia>vitreal haemorrhage due to low platelets
sickle cell>conjunctival haemorrhage
pernicious anaemia>optic atrophy(B12 needed for nerve function).
Ocular features in other metabolic diseases (4)
hyperthyroidism: exopathalmos, lid/peri-orbital oedema. Rx w. radioiodine (radioiodine and rapid Rx can worsen eye disease)
hypoparathyroidism: lens opacification due to hypocalcaemia (cataracts)
hyperparathyroidism: corneal and conjunctival calcification
gout: monosodium urate deposition in conjunctiva leads to soreness
the eye in granulomatous disorders (5)
TB, toxoplasmosis, sarcoid, leprosy, brucellosis>uveitis
the eye in collagen/vasculitic diseases (4)
conjunctivitis: -Reiter's SLE episcleritis: -polyarteritis nodosa, SLE scleritis: -RA uveitis: -ank spond, reiter's, bechet's, IBD
Features of keratoconjunctivitis sicca (3)
decreased tear formation>gritty feeling in eyes
xerostomia (dry mouth) due to decreased salivation
occurs in assoc. w. other collagen diseases.
Rx of eye Sx in keratoconjunctivitis sicca (2)
pilocarpine or cemiveline for sicca Sx
topical ciclosporin helps moderate to severe dry eye.
Features of sarcoidosis (9)
VII palsy lacrimal gland enlargment conjunctival granulomata dry eye optic neuritis cataract-due to steroids and uveitis retinitis choroiditis granulomatous iritis
The eye in HIV (2)
CMV retinitis:
- mozarella pizza appearance
- flame haemorrhages
- implies low CD4
- Rx w. IV ganciclovir or valganciclovir
HIV retinopathy> cotton wool spots.
