Trans 013 Ocular Manifestation Of Systemic Disease

Question 1

Overall incidence of Hypertensive Retinopathy

Answer 1

15%

Question 2

Keith Wagener Barker Classification

disc edema

Answer 2

Stage 4

Question 3

Keith Wagener Barker Classification

Cotton wool spots hard exudates, Retinal hemorrhage

Answer 3

Stage three

Question 4

Keith Wagener Barker Classification

Moderate to marked arteriolar narrowing, av crossing changes

Answer 4

Stage 2

Question 5

Keith Wagener Barker Classification

Mild to moderate arteriolar narrowing

Answer 5

Stage 1

Question 6

Scheie Classification : Hypertension

No changes

Answer 6

Grade zero

Question 7

, Scheie Classification : Hypertension

Obvious arterial narrowing

Answer 7

Grade 2

Question 8

Scheie Classification : Hypertension

Plus retinal hemorrhage

Answer 8

Grade 3

Question 9

Scheie Classification : Hypertension

Plus puppiledema

Answer 9

Grade 4

Question 10

Scheie Classification: Arteriosclerosis

Obvious increased light reflex changes

Answer 10

Grade two

Question 11

Scheie Classification: Arteriosclerosis

Silver wire arterioles

Answer 11

Grade four

Question 12

Scheie Classification: Arteriosclerosis copper wire arterioles

Answer 12

Grade three

Question 13

In accelerated hypertension (malignant – acute, hypertensive crisis), as in Toxemia of Pregnancy, Essential HPN, Renal Disease, Tumors, Connective Tissue Disorders
• Acute phase: yellow spots at the level of the retinal pigment epithelium
• Pathology: fibrinoid necrosis of choriocapillaris, with damage to RPE / intense plasma leakage can cause exudative retinal detachment / later, lesions scar with pigment or depigmentation.
 This complication only happens on acute accelerated hypertension, toxemia of pregnancy na mag cause ng exudative retinal detachment.

Answer 13

HYPERTENSIVE CHOROIDOPATHY

Question 14

May be a direct ischemic episode of the optic nerve : Ischemic Neuropathy
• Upon resolution, many develop optic atrophy

Answer 14

HYPERTENSIVE OPTIC NEUROPATHY

Question 15

there is intact eye movement but

there is no vision. Normal and MRI, yun pala may stroke sa occipital cortex

Answer 15

Cortical blindness

Question 16

Remember that you will only see the cherry red spot in 2 instances

Answer 16

one is in central retinal artery occlusion, second is the tay sachs disease

Question 17

usually in elderly people with systemic vascular disease : more in men than women (

2:1) : at least 90% carotid stenosis atherosclerosis most common cause 40%
; 20% bilateral : : 5 yr. mortality rate is

Answer 17

Ocular Ischemic Syndrome

Question 18

vegetations from valves become emboli and cause retinal vascular occlusion

Answer 18

Subacute Infectious Endocarditis

Question 19

from distant sites : operative sites, cardiac valves, cholesterol plaques

Answer 19

Embolic phenomena

Question 20

Risk factors in having diabetic retinopathy

Answer 20

Duration of Diabetes
• Glycaemic Control
• Age
• Type of Diabetes
• Family Hx of DM
• Blood Pressure
• Serum Lipids
• Nutritional Factors/Obesity
• Clotting Factors
• Renal Disease

Question 21

Funds changes in

Non proliferative -Diabetic Retinopathy)

Answer 21

• Microaneurysms
• Retinal hemorrhages
• Hard exudates
• Cottonwool spots or soft exudates
• Venous beading
• Intraretinal microvascular abnormalities

Question 22

Fundus Changes in Proliferative Diabetic Retinopathy (PDR)

Answer 22

• Neovascularization of the disc and retina
• Vitreous and preretinal hemorrhages
• Fibrovascular membranes
• Vitreoretinal traction

Question 23

Causes of visual loss in

Diabetic retinopathy

Answer 23

Macular Edema
• Macular / Premacular Hemorrhage
• Massive Vitreous Hemorrhage
• Traction Retinal Detachment
• Rhegmatogenous Retinal Detachment
• Neovascular Glaucoma
 Visual loss and retinal changes are irreversible.
 Early detection of Diabetic Retinopathy is crucial in blindness
prevention.

Question 24

It there is diabetes at zero to 29 years old when is the recommended time of first exam? Follow up?

Answer 24

5 years after onse t;

yearly

Question 25

Dm at 30 years and older when is the first exam? Follow up?

Answer 25

At time of diagnosis Yearly

Question 26

Prior to frequency dm when is the first exam? Follow up?

Answer 26

Prior to conception or early in first trimester No retinopathy to non server: every 3-12 months; other stages 1-3 months

Question 27

Management Diabetic retinopathy

Answer 27

• Strict blood sugar control • Management of other systemic problems • Dilated fundus examinations • Pan retinal Photocoagulation (PRP) for High Risk PDR / Early PDR / Severe-Very Severe NPDR • Macular Grid and Focal Photocoagulation for macular edema • Anti VEGF intravitreal injections / intravitreal steroid injections or implants for Macular edema • Vitreoretinal surgery for advanced cases

Question 28

* Most common cause of unilateral or bilateral proptosis in adults and children * usually bilateral (pwede din na unilateral) * immune-mediated process * 4-5x more in females, usually middle age

Answer 28

dysthyroid ophthalmopathy, Graves’ ophthalmopathy ” May our in euthyroid state

Question 29

What disease? Pathophysiology • Chronic inflammation and scarring • infiltration of EOMs & orbital fat by inflammatory cells first then mucopolysaccharide and collagen • disease process is marked by early inflammation & long term fibrosis and scarring

Answer 29

dysthyroid ophthalmopathy, Graves’ ophthalmopathy ”

Question 30

What disease! • Non-specific redness, irritation, chemosis, lid swelling  Chemosis is the swelling of the conjunctiva and the lids • Lid retraction, lid lag • Eyelid retraction, proptosis, motility restriction  Kasi diba naka prop outward yung eyes kaya pwedeng prone sa keratitis ang patient • Corneal exposure • Optic nerve compression  In very severe cases you will see this. *** entire process: 6-24 mo. active disease, ff by stability and scarring in the orbit

Answer 30

dysthyroid ophthalmopathy, Graves’ ophthalmopathy ”

Question 31

Management of Dysthyroid ophthalmopathiy

Answer 31

• Patient education • Evaluation and monitoring of thyroid problem • Monitoring of vision, color vision, pupillary reflexes • Careful evaluation for optic nerve compression, corneal exposure • Ocular surface lubricants • Active: ocular lubricants, orbital irradiation, systemic steroids, orbital decompression • Chronic: observation, ocular lubricants, surgery for muscles, orbital decompression, lid surgery

Question 32

Opportunistic Infections: in AIDS

Answer 32

Cytomegalovirus, Candida, Herpes Zoster, Toxoplasmosis, Pneumocystis Carinii

Question 33

most common finding in 100% of | HIV infected patients

Answer 33

Cotton wool spots

Question 34

most frequent is posterior granulomatous choroiditis • retinal vasculitis with sheathing is common vitritis • chronic iridocyclitis • endophthalmitis

Answer 34

Ocular tuberculosis

Question 35

are found in pork meat, and other tapeworms like D. latum. The larvae get into the system and then get into the eye.

Answer 35

Cysticercosis

Question 36

drying of conjunctiva and cornea, Bitot’s Spots, keratomalacia, night blindness.

Answer 36

xerophtalmia

Question 37

Corrugated sa eyes? Melt down of Correa?

Answer 37

Bitot'S spot Keratomalacia

Question 38

crushing injuries of head or chest • complement-activated coagulation of leukocytes, plus other microemboli

Answer 38

Purstcher’s Retinopathy

Question 39

Some medicine that cause retinopathy

Answer 39

Chloroquine tamoxifen thioridazine

Question 40

IMMUNOLOGIC / COLLAGEN DISEASE that cause Retinal vas colitis

Answer 40

Juvenile Rheumatoid Arthritis

Question 41

IMMUNOLOGIC / COLLAGEN DISEASE that cause uveitis

Answer 41

Hashimoto Thyroiditis