week 2 eye in systemic disease: systemic disease Flashcards
what kinds of systemic disease can cause eye disease?
CV disease
inflammatory
CTD
what CV disease can cause eye disease?
Diabetes
Hypertension
Vascular Occlusion
what inflammatory disease can cause eye disease?
Granulomatous Disease
Giant Cell Arteritis
Thyroid Eye Disease
what CTD disease can cause eye disease?
SLE
RA
marfans
pathogenesis of diabetic retinopathy
chronic hyperglycaemia→ glycosylation of protein/basement membrane→ loss of pericytes→ micro aneurysm →leakage and ischaemia
Signs of non proliferative diabetic retinopathy
microaneurysms / dot + blot haemorrhages hard exudate cotton wool patches abnormalities of venous calibre Intra-retinal microvascular abnormailities (IRMA)
are new vessels good at back of diabetic eye?
No.
try to avoid these as they easily haemorrhage leading to fibrosis and loss of function
what types of new vessels can be seen in diabetic retinopathy?
grow on disc (NVD)
grow in the periphery (NVE)
grow on iris if ischaemia is severe (blindness precedes this usually )
what is Rubeosis iridis?
neovascularisation of the iris. (late sign), grows into trabecular meshwork and stops aqueous draining out of the eye, leading to very high IOP and is painful (potentially glaucoma too)
what is usual IOP?
<21
why do diabetic patient lose vision?
- retinal oedema affecting the fovea
- vitreous haemorrhage
- scarring/ tractional retinal detachment
how is diabetic retinopathy classed?
No retinopathy
non-proliferative: =mild, moderate, severe
proliferative retinopathy
how is diabetic eye disease assessed?
retinopathy and maculopathy
how is diabetic maculopathy classed?
No maculopathy
observable maculopathy
referable maculopathy
clinically significant maculopathy
how is diabetic eye disease managed?
Optimise medical management
Laser = PRP, Macular grid
Surgery – vitrectomy
Rehabilitation (blind/partial sighted)
features of hypertensive retinopathy?
Attenuated blood vessels-copper or silver wiring cotton wool spots hard exudates retinal haemorrhage optic disc oedema
what is particularly concerning about accelerated hypertension?
Particularly in young patients
very dramatic fundal appearance
can have decreased vision
what is central retinal artery occlusion PC
Sudden painless loss of vision
very profound loss of vision
what occurs in fundoscopy of CRAO
retinal nerve fibre layer becomes swollen except at fovea (cherry red spot)
[rarely recovers]
PC of CRVO
Sudden painless visual loss
range of visual loss
what needs to be assessed in CRVO
need to determine degree of ischaemia
Ischaemia correlates to degree of reduced vision and fundal appearances
PC of Branch vein occlusion
Painless disturbance in vision
may be assymptomatic
may be aware of loss of part of field
examples of what can cause uveitis
Infective = TB Herpes Zoster Toxoplasmosis Candidiasis Syphilis Lyme Disease
Non-Infective= Idiopathic Syndromes HLA-B27 Juvenile Arthritis Sarcoidosis Behcet’s Disease
GCA: what is it, associated with what, PC
Inflammation of middle sized arteries associated with polymyalgia rheumatica Headache jaw claudication Malaise Raised P.V. Blinding Condition
feature of TED
EXTRAOCULAR Proptosis Lid signs: -retraction -oedema -lag -pigmentation Restrictive myopathy
OCULAR Anterior Segment -chemosis -injection -exposure -glaucoma Posterior Segment -choroidal folds -optic nerve swelling
what pathophysiology occurs in TED?
Characterised by swelling of the extraocular muscles and orbital fat
how to treat TED?
Control of thyroid dysfunction
lubricants
surgical decompression
features of SLE
Multisystem immunological disease
anti-DNA Ab
ocular inflammation
features of RA eye disease
Dry eyes (Keratoconjunctivitis Sicca)
Scleritis
Corneal melt
SJOGREN’S SYNDROME pathogenesis
infiltration of lacrimal glands
SJOGREN’S SYNDROME triad
- keratoconjunctivitis sicca
- xerostomia
- Rheumatoid Arthritis (usually)
marfan’s syndome
len dislocation
nearsightedness
others…
Stevens-Johnson syndrome eye disease
Symblepharon
occlusion of lacrimal glands
corneal ulcers
