The Eye in Systemic Disease Flashcards
Describe the disease process that leads to ischaemia of the eye in diabetes?
Chronic hyperglycaemia-> Glycosylation of protein/basement membrane -> loss of pericytes -> microaneurysm-> leakage and ischaemia
What are the signs of non-proliferative retinopathy?
Microaneurysm/Dot and blot haemorrhages
Hard exudate
Cotton wool patches
Abnormalities of venous calibre
Intraretinal microvascular abnormalities
Describe the pattern of new vessel growth in diabetes?
Grow on disc
Grow in the periphery
Grow on iris if ischaemia is severe
What causes diabetic patients to lose vision?
Retinal oedema affecting the fovea
Vitreous haemorrhage
Scarring/tractional retinal detachment
Describe Classification 1: retinopathy
- No retinopathy
- Mild/moderate/ severe (non proliferative)
- Proliferative
Describe Classification 2: Maculopathy
- No maculopathy
- Observable maculopathy
- Referable maculopathy
- Cliniccaly significant maculopathy
How is diabetic eye disease managed?
Glycaemic control
Laser
- Panretinal Photocoagulation (PRP)
- macular grid
Surgery
-vitrectomy
Rehabilitation
What does the appearance of the fundus correlate to in hypertension?
Severity of hypertension and the state of the retinal arterioles
What are the features of hypertensive retinopathy?
Attenuated blood vessels- copper or silver wiring Cotton wool spots Hard exudates Retinal haemorrhage Optic disc oedema
Describe accelerated hypertension
Particularly in young patients
Very dramatic fundal appearance
Can have decreased vision
What is the cherry red spot in CRAO?
Retinal nerve fibres become swollen apart from fovea (cherry red spot)
Define a rubeotic eye
Neovascularisation of the iris
Describe a branch retinal vein occlusion
Painless disturbance in vision, may be asymptomatic, may be aware of loss of part of visual field
What are the causes of non-infective uveitis
Sarcoidosis
HLA-B27
Juvenile arthritis
Bechet’s disease
What are the infective causes of uveitis?
TB HZ Toxoplasmosis Candidiasis Syphillis Lyme disease
What is GCA associated with?
Polymyalgia rheumatica
What are the signs and symptoms of GCA?
Jaw claudication
Malaise
Raised plasma viscosity
Blinding condition
What may be seen in extraocular thyroid eye disease?
Proptosis
Lid Signs
Restrictive myopathy
What are the lid signs found in thyroid eye disease?
Retraction
Oedema
Lag
Pigmentation
What may be seen in the anterior compartment in thyroid eye disease?
Chemosis
Injection
Exposure
Glaucoma
What may be seen in the posterior compartment in thyroid eye disease?
choroidal folds
optic nerve swelling
What characterises thyroid eye disease?
Swelling of extraocular muscles and orbital fat
How should thyroid eye disease be managed?
Control of thyroid dysfunction
Lubricants
Surgical decompression
What are the manifestations of SLE in the eye?
Ocular inflammation
What are the manifestations of rheumatoid arthritis in the eye?
Keratoconjunctivitis Sicca
Scleritis
Corneal melt
What is the triad of sjogrens disease?
Keratoconjunctivitis sicca
Xerostomia
Rheumatoid arthritis
What is an ocular manifestation of sjogrens disease?
Inflammation of lacrimal glands
What are some of the ocular manifestations of marfans syndrome
- dislocated lenses
- retinal detachment
- severe myopia
- astigmatism
- amblyopia
- strabismus
- glaucoma
- pre-senile cataracts (before age 40)
- flattened corneal curve
- larger cornea
- exophthalmos
- difficult pupil dilatation
What is seen in stevens-johnson syndrome?
Symblepharon
Occlusion of lacrimal glands
Corneal ulcers
What is Symblepharon?
Adhesions
