The Eye in Systemic Disease Flashcards
Describe the pathogenesis of diabetic retinopathy
chronic hyperglycaemia
glycosylation of protein/basement membrane
loss of pericytes (cells that wrap around capillaries)
microaneurysm
microaneurysm causes leakage and ischaemia which causes proliferation of blood vessels
What is the earliest sign of diabetic retinopathy?
Microaneurysm
What may diabetic maculopathy be caused by?
Capillary leakage giving rise to chronic macular oedema
Lipid deposition in the macular area
Extensive obliteration of the macular capillaries
Treatments of diabetic eye disease?
Maximise glycemic control
Eye screening
New vessels are indication for laser photocoagulation therapy
If new vessels on the optic disc then pan retinal photocoagulation is carried out which involves laser burns to the peripheral retina
In hypertensive retinopathy the appearance of fundus correlates to ______________________
severity of hypertension and the state of the retinal arterioles
Causes of occlusion of the central retinal artery?
1) Thrombosis in a central retinal artery damaged by atherosclerosis or hypertension (most common)
2) Emboli
3) Inflammatory changes in central retinal artery due to GCA
Cherry red spot?
Occlusion of the central retinal artery
How will the fundus appear in central retinal artery occlusion?
Arteries narrowed and retina is opaque (usually retinal is transparent). A cherry red spot is seen at the fovea as the choroidal vasculature shows up through the thinnest part of the retina.
Symptoms of central retinal artery occlusion
Sudden, painless and profound loss of vision that rarely recovers
Explain the appearance of the funds in central retinal vein occlusion?
Thrombosis causes obstruction to the outflow of blood leading to a rise in intravascular pressure. This results in dilate veins, retinal haemorrhage, cotton wool spots and abnormal leakage of fluid from vessels causing retinal oedema.
Predisposing factors to CRVO?
Increasing age, hypertension, CV disease, diabetes, glaucoma and in younger blood dycrasias (disorder) and vasculitis
What part of the eye can be effected by rheumatoid arthritis? What can happen?
Collagenous coats of the eye (sclera and cornea) or the lacrimal gland
Scleritis and corneal melt
Sjrogens syndrome effects on eyes?
Inflammation of the cornea and conjunctivitis (due to inflammatory and degenerative changes in the lacrimal gland)
Dry eyes
Most patients with sjrogens syndrome have…
another autoimmune condition e.g. rheumatoid arthritis
Symptoms of sjrogens syndrome?
Dry eyes- gritty feeling Dry mouth Dry throat Vaginal dryness Bilateral parotidd enlargement Generalised aches and pains Fatigue Unexplained increase in dental caries
What is sarcoidosis?
Non-caseating granulomatous disease of unknown cause. Multi-system disease.
Eye manifestation of sarcoidosis?
Uveitis
Afro caribbean, red eye, bilateral hilar lymphadenopathy?
Sarcoidosis
What is associated with non-infective uveitis?
HLA B27 > seronegative spondyloarthopathies
Ankylosing spondylitis, Reiters/ reactive arthritis, enteropathic arthritis, psoriatic arthritis
What other rheumatic condition is giant cell arteritis/ temporal arteritis associated with?
Polymyalgia rheumatica
What is giant cell arteritis?
Large vessel vasculitis of large cerebral arteries which occurs in association with PMR. It is granulomatous.
Signs and symptoms of giant cell arteritis?
Severe headaches, tenderness of scalp or the temple, claudication of the jaw when eating, tenderness or swelling of one or more temporal or occipital arteries. Despite the swelling there is reduced pulsation.
Why is it important to identify giant cell arteritis?
It can involve the ophthalmic artery which supplies the anterior part of the optic nerve (much less commonly the central retinal artery is occluded). CAN CAUSE LOSS OF VISION.
Effect of GCA on the eye?
Painless, temporary or permanent loss of vision in one eye
Investigations of GCA?
Bloods: ESR, PV and CRP
US first test of choice
Temporal artery biopsy is gold standard and definitive test
Treatment of GCA?
Prednisolone 40-60mg then reduce gradually
What age of people tend to get GCA and PMR?
Extremely rare in under 50
Eye changes in SLE?
Scleritis
Changes in skin around the eye
In mild Thyroid eye disease what are the features?
Eyes are prominent with a degree of lid retraction and lid lag
How does autoimmune reaction cause serious eye problems in Graves?
Autoimmune reaction in the orbit causes oedema and lymphocytic infiltration of both the orbital fat and muscles.
Describe features of serious thyroid eye disease?
Proptosis Lid retraction, oedema and lag Ohpthalmaplegia Chemosis, injection, exposure, glaucoma Choroidal folds and optic nerve swelling
What is Marfans syndrome?
Autosomal dominant or sporadic mutation in fibrillin gene (glycoprotein essential for elastic fibres in connective tissue) which realist in tall stature and disproportionately long limbs and ligamentous laxity.
What eye problems can arise in Marfans syndrome?
Lens dislocation (superior temporal direction) as effects collagen in zonules of lens
Copper wiring happens in what type of retinopathy?
Hypertensive
8 causes of acute red eye?
1) Conjunctivitis
2) Subconjunctival haemorrhage
3) Keratitis
4) Episcleritis
5) Scleritis
6) Acute anterior uveitis
7) Corneal Abrasion
8) Acute angle closure glaucoma
Anterior uveitis involves what 2 components?
Iris and ciliary body
Sore eye, blurring of vision, photophobia, fluid level hypopyon?
Acute anterior uveitis
Needs same day referral to ophthalmology
Presentation of acute anterior uveitis?
Red painful eye, photophobia, conjunctival injection, blurred vision, pupil may irregular and constricted and react sluggishly to light, hypopyon may be present
Acute anterior uveitis may be related to …
HLAB27
Treatment of acute anterior uveitis?
Mydriatics and steroids
Most cases of scleritis are associated with? Treatment?
RA and GPA
Need specialist referral as sight threatening and may require systemic immunosuppression
