The Eye in Systemic Disease Flashcards
What is the biggest cause of visual loss in the working population?
Diabetic retinopathy
Chronic hyperglycaemia results in the formation of what in diabetic retinopathy? What does this lead to?
Microaneurysm, which leads to leakage and ischaemia
What is meant by proliferative retinopathy?
New vessels start to form
What are some signs of non-proliferative retinopathy?
Microaneurysms (dot and blot haemorrhages), hard exudate, cotton wool patches, venous and microvascular abnormalities
Non-proliferative retinopathy can be divided into what?
Mild, moderate and severe
Where can new vessels grow in diabetic retinopathy?
On the disc (NVD), on the periphery (NVE) and very rarely on the iris
Why do diabetic patients lose vision?
Retinal oedema affecting the fovea, vitreous haemorrhage, retinal detachment
What are the 4 stages of diabetic maculopathy?
None, observable, referable, clinically significant
What are the management options for diabetic retinopathy?
Optimising diabetic control, laser treatments, vitrectomy, rehabilitation
In hypertensive retinopathy, the appearance of the fundus correlates to what?
The severity of the hypertension and the state of the retinal arterioles
Which patients with hypertensive retinopathy tend to have severe disease?
Young patients
Who does accelerated hypertension occur in and what does it cause?
Occurs in young patients and causes a dramatic fundal appearance and decreased vision
What condition does giant cell arteritis have an association with?
Polymyalgia rheumatica
What characterises thyroid eye disease?
Swelling of the extraocular muscles and orbital fat
What is the most common cause of unilateral and bilateral proptosis? What kind of condition is this?
Thyroid eye disease, autoimmune condition
What is the major risk of thyroid eye disease?
Compartment syndrome which can affect the optic nerve
What are some extraocular signs of thyroid eye disease?
Proptosis, restrictive myopathy (poor movement), lid signs e.g. retraction, oedema, lag, pigmentation
What is chemosis?
Swelling of the conjunctiva
Thyroid eye disease can lead to what other eye condition?
Glaucoma
What may be seen in the posterior segment of an individual with thyroid eye disease?
Choroidal folds, optic nerve swelling
What are management options for thyroid eye disease?
Control of thyroid hormones, lubricants, surgical decompression
Which connective tissue diseases can cause eye symptoms
SLE, RA, Sjogren’s, Marfan’s
What can rheumatoid arthritis cause?
Keratoconjunctivitis sicca, scleritis, corneal melt
What is the main eye condition that Sjogren’s will cause?
Keratoconjunctivitis sicca
What eye condition is likely to occur in Marfan’s syndrome?
Lens dislocation
What is erythema multiforme?
A hypersensitivity reaction which occurs following an infection, usually with HSV
What are some eye symptoms that Stevens Johnsons Syndrome and erythema multiforme can cause?
Conjunctivitis, occlusion of lacrimal glands, corneal ulcers
What will a sixth nerve palsy result in?
Failure to abduct the affected eye
What will a fourth nerve palsy result in?
Intorsion, depression in adduction, weak abduction
What may patients with a 4th nerve palsy do to try and compensate?
Head tilt
What can bilateral 4th nerve palsy cause?
Torsion and chin depression
What usually causes bilateral 4th nerve palsy?
Head trauma
What muscles does a 3rd nerve palsy affect?
MR, IR, SR, IO, sphincter pupillae, LPS
What will the ocular position be in a 3rd nerve palsy?
Down and out
If a 3rd nerve palsy is painful, what is the most likely cause?
Aneurysm
What is the most likely cause of all nerve palsies?
Microvascular or tumours
If not microvascular/tumour, what is the most likely cause of a 4th nerve palsy?
Trauma or congenital
If not microvascular/tumour, what is the most likely cause of a 6th nerve palsy?
Raised ICP
What are some causes of visual field defects?
Vascular disease, space occupying lesion, demyelination, trauma
What condition is optic neuritis associated with?
MS
What will optic neuritis cause?
Progressive unilateral visual loss with pain behind the eye, especially on eye movements
Optic neuritis results in optic atrophy- what will this show on ophthalmoscopy?
Large cup to disc ratio
Problems at the optic chiasm cause what visual field defect?
Bitemporal hemianopia
Defects at the optic chiasm are usually caused by what?
Tumours (pituitary tumours, craniopharyngiomas, meningiomas)
Are bitemporal hemianopias reversible?
Usually once the tumour is removed
What kind of visual field defect will problems at the optic tract and radiations cause? What can this result in? Is this incongruous or congruous?
Homonomous defects where the macula is not spared - can cause quadrantinopia. This is incongruous.
What kind of visual field defect will problems at the visual cortex cause? Is this incongruous or congruous?
Homonomous defects which are macula sparing. This is congruous.
