The Eye in Systemic Disease Flashcards
name the 5 signs of non proliferative retinopathy
- micro aneurysms - dot and blot haemorrhages
- hard exudate
- cotton wool patches
- abnormal venous calibre
- IRMA - intra-retinal microvascular abnormalities
loss of _________ results in microaneurysms
loss of PERICYTES results in microaneurysms
which 3 places can new vessels grow?
- disc (NVD)
- periphery (NVE)
- iris if ischaemia is severe
what is rubeosis iridis?
growth of new vessels onto the iris
name the 3 things that diabetic patients can lose vision from
- retinal oedema
- vitreous haemorrhage
- scarring and retinal detachment
name the 3 classifications of retinopathy
- no retinopathy
- non-proliferative retinopathy - mild, moderate and severe
- proliferative retinopathy
name the 4 classifications of maculopathy
- no maculopathy
- observable maculopathy
- referable maculopathy
- clinically significant maculopathy
name the management for diabetic retinopathy (4)
medical management
laser - PRP or macular grid
surgery
rehabilitation
cotton wool patches are seen in diabetic patients but also in patients with what condition?
hypertension
name the 5 features of hypertensive retinopathy
- attenuated blood vessels-copper or silver wiring
- cotton wool spots
- hard exudates
- retinal haemorrhage
- optic disc oedema
sudden painless loss of vision
cattle trucking of artery
very profound loss of vision
retinal nerve fibre layer becomes swollen except at fovea (cherry red spot)
rarely recovers
diagnosis?
central retinal artery occlusion
sudden painless visual loss
range of visual loss
need to determine degree of ischaemia
Ischaemia correlates to degree of reduced vision and fundal appearances
diagnosis?
CRVO
what does a robotic eye look like?
vessels surrounding pupil encroaching on the iris
google it
- common in Africa
- huge exudation on fundus
- bilateral hiliar lymphadenopathy on CXR
diagnosis?
sarcoidosis
name some infective and non-infective causes of uveitis
infective - TB, herpes zoster, toxoplasmosis…
non-infective - idiopathic, HLA-B27, juvenile arthritis, sarcoidosis
- enlarged temporal artery
- old pathient
- swollen optic nerve head
diagnosis?
giant cell arteritis
what condition is giant cell arteritis associated with?
polymyalgia rheumatica
name the symptoms of giant cell arteritis
headache jaw claudication malaise raised PV blinding condition
name the main feature of thyroid eye disease
proptosis
name the important antibody in SLE that causes ocular inflammation
anti-DNA Ab
dry eyes (keratoconjunctivitis sicca), scleritis and corneal melt is seen in which inflammatory condition?
rheumatoid arthritis
the following triad:
keratoconjunctivitis sicca
xerostomia
rheumatoid arthritis
is seen in which syndrome?
sjogren’s syndrome
lacrimal glands are also infiltrated
lens displacement without trauma, long fingers and a high arched palate is seen in what condition?
marfans
which way is the lens displaced in marfans syndrome?
UP!
symblepharon
occlusion of lacrimal glands
corneal ulcers
dermatological diagnosis?
stevens-johnson syndrome
what is the gold standard imaging technique to identify cause of eye disease?
MRI scanning
name the following nerves:
(a) CN III
(b) CN IV
(c) CN VI
(a) CN III - oculomotor
(b) CN IV - trochlear
(c) CN VI - abducens
what eye muscle does CN VI supply?
lateral rectus muscle
what does the lateral rectus muscle do?
adduction of the eye
name the main cause and other causes of VIth nerve palsy
main: raised ICP
other: microvascular, tumour and congenital
what muscle does the IVth nerve supply?
superior oblique
what actions does the superior oblique muscle perform
intorsion
depression in adduction
abduction (weak)
what is seen in a patient with a IVth nerve palsy?
head tilt
right tilt if left IV palsy
left tilt if right IV palsy
what is the main cause of IVth nerve palsy?
congenital decompensated (inability to fuse images together) and trauma
what muscles do CN III innervate?
all the rest
medial rectus muscle inferior rectus superior rectus inferior oblique sphincter pupillae levator palpebrae superioris
what is the ocular position in a IIIrd nerve palsy?
down and out
name the main and other causes of a IIIrd nerve palsy
main: aneurysm (circle of willis)
other: microvascular, tumour, MS and congenital
what should you suspect in a painful IIIrd nerve palsy?
ANEURYSM!!!
inter-nuclear ophthalmoplegia is seen in patients that have had what?
a stroke
inter-nuclear ophthalmoplegia causes?
multiple sclerosis - demyelination is main and vascular is other
name the most common pathology of the optic nerve
ischaemic optic neuropathy
name the pathology of the optic nerve that is seen commonly in MS
optic neuritis
optic nerve defects are ________ or abide the __________
optic nerve defects are COMPLETE or abide the HORIZONTAL
progressive visual loss (unilateral)
pain behind eye, especially on movement
colour desaturation
central scotoma
gradual recovery over weeks - months
diagnosis?
optic neuritis
name the most common pathology at the optic chiasm
pituitary tumour
also craniopharyngioma and meningioma
what visual field is seen in pathology of the optic chiasm
bi-temporal field defect
is visual loss reversed after a pituitary tumour is removed?
yes
what pathology is seen in the optic tracts and radiation?
tumours
demyelination
vascular anomalies
what visual field defect is seen in pathology of the optic tract?
homonomous defects
macula not spared
quadrantanopia
incongruous (non-symmetrical)
what pathology is seen at the occipital cortex and what is the visual field defects enthuse patients?
pathology: vascular disease and demyelination
visually: homonomous defect, macular sparing and congruous (symmetrical)
