27. Systemic Disease and the Anterior Eye Flashcards
What are the categories of systemic disease? (8 types)
Congenital, vascular, neoplastic, autoimmune, atopic, infectious, metabolic/endocrine, drugs/chemotherapy/biologics/toxins.
Neurofibromatosis (... disorder)
One of the ... inherited disorders (... in ... prevalence). There are distinctive .../..., with ..., and .... ...% of cases have ....
Neurofibromatosis (congenital disorder)
One of the most common inherited disorders (3 in 10000 prevalence). There are distinctive hyperpigmented skin macules/cafe-au-lait spots, with osseous bone lesions, and glioma of the visual pathway. 90% of cases have iris lisch nodules.
Diabetes (... disease)
One of the main ... of systemic disease; gotta watch out for ... and ... of meds.
Associated with ... which is evident in the .... Diabetic eyes are at increased risk of ..., ..., and ....
Pathogenesis is related to: 1) ... in corneal epithelium, 2) abnormalities of ..., and 3) loss of ....
Diabetes (metabolic/endocrine disease)
One of the main ocular complications of systemic disease; gotta watch out for dry eyes and anterior side effects of meds.
Associated with impaired wound healing which is evident in the corneal epithelium. Diabetic eyes are at increased risk of SPK, recurrent corneal erosion syndrome, and persistent epithelial defects.
Pathogenesis is related to: 1) defective wound healing in corneal epithelium, 2) abnormalities of sub-basal nerves, and 3) loss of corneal endothelial pump function.
Sjogren’s Syndrome (... condition)... and ... associated with antibodies anti-SS-a, anti-SS-b, and anti-Ro. Requires ... checking for ... and ..., which would be sent to the ....
Condition affects the ... of mucous membranes. Secondary disease is associated with ..., ..., and .... ... and inflammation of ... leads to decreased tear production. Results in ....
Sjogren’s Syndrome (autoimmune condition)Dry eyes and dry mouth associated with antibodies anti-SS-a, anti-SS-b, and anti-Ro. Requires blood tests checking for inflammatory markers and antibody markers, which would be sent to the rheumatologist.
Condition affects the exocrine glands of mucous membranes. Secondary disease is associated with rheumatoid arthritis, systemic lupus erythematosus, and granulomatosis with polyangiitis. Lymphocytic infiltration and inflammation of lacrimal glands leads to decreased tear production. Results in dry eye.
Ankylosing spondylitis (... condition)
Up to ...% of patients with this have one or more episodes of .... Results in ..., ..., ..., and ....
Ankylosing spondylitis (autoimmune condition)
Up to 25% of patients with this have one or more episodes of anterior uveitis. Results in photophobia, redness, ache-pain, and decreased vision.
Rheumatoid arthritis is associated with ..., ..., ..., ..., and ....
Rheumatoid arthritis is associated with dry eyes, episcleritis, scleritis, uveitis, and corneal immune ulcers.
Episcleritis is an ... disease of the .... Results in dilation of ... and ....
...% of cases are ... and typically affects .... Often associated with ..., ..., ..., ..., and ....
Patients with episcleritis have ...; treat with ... such as ... or ... dosage regimen and then taper.
Episcleritis is an autoimmune, inflammatory disease of the superficial tissue overlying the sclera. Results in dilation of superficial vessels and oedema.
70% of cases are idiopathic and typically affects young women. Often associated with gout, rhuematoid arthritis, lupus, connective tissue disorders, and other systemic diseases.
Patients with episcleritis have severe pain; treat with topical steroids such as flarex or pred forte qid and then taper.
Scleritis is an ... disease of the .... Patient will be in ... and sclera may have .... In terms of diagnostics, if the ... and ... vessels blanch but the ... vessels don’t after ..., most likely scleritis.
Scleritis is an autoimmune, inflammatory disease of the sclera. Patient will be in severe pain and sclera may have blueish hue. In terms of diagnostics, if the conjunctival and episcleral vessels blanch but the scleral vessels don’t after phenylephrine, most likely scleritis.
Juvenile rheumatoid arthritis is an ... disease. ... on blood test. Has a triad of eye signs: ..., ..., and ....
Juvenile rheumatoid arthritis is an autoimmune disease. ANA positive on blood test. Has a triad of eye signs: iritis, early cataract, and band keratopathy.
Sarcoidosis is an ... disease that is a ... of ... aetiology. Looks like ..., which is ... on the corneal epithelium.
Sarcoidosis is an autoimmune disease that is a multisystem disorder of unknown aetiology. Looks like granulomatous uveitis, which is large keratic percipitates on the corneal epithelium.
Systemic lupus erythematosus (SLE) is an ... disease which is associated with ..., ..., and .... Have to differentiate from ... and most severe involvement is the ....
Systemic lupus erythematosus (SLE) is an autoimmune disease which is associated with dry eye, (epi)scleritis, and immune corneal ulcers. Have to differentiate from infectious microbial keratitis and most severe involvement is the posterior eye.
Immune corneal ulcers result in decrease ..., ..., no ... or ..., and mild .... They present with ..., ... shape, on the ..., quite ....
Immune corneal ulcers result in decrease corneal sensation, minimal pain, no discharge or change in anterior chamber, and mild conjunctival injection. They present with rolled edges, oval shape, on the lower half of the cornea, quite shallow.
Neurotrophic keratitis: .... Symptoms include ..., ..., ..., and decreased .... Signs include ..., ..., ..., and ....
Many causes: ..., ..., ..., ..., ..., and .... Systemic disease causes are ..., ..., and .... Ocular disease causes are ..., ..., ..., ..., ..., and abuse of ....
Neurotrophic keratitis: corneal hypoaesthesia associated with epithelial irregularities. Symptoms include redness, tearing, burning, foreign body sensation, and decreased VA. Signs include decreased corneal sensitivity, interpalpebral PEE, epithelial defects, and secondary infection.
Many causes: acquired damage to CNV, surgical ablation, stroke, aneurysm, MS, and acoustic neuroma. Systemic disease causes are diabetes, autoimmune diseases, and immunocompromisation. Ocular disease causes are HSK, HZO, chemical burn, refractive corneal surgery, other corneal surgeries, and abuse of topical anaesthetic.
Neurotrophic keratitis - major cause is damage to ....
Damage here results in reduced acetylcholine and growth factors from the epithelium. Results in reduced ... and ..., loss of ..., exfoliation of ..., ..., and impairment of ....
Neurotrophic keratitis - major cause is damage to trigeminal nerve.
Damage here results in reduced acetylcholine and growth factors from the epithelium. Results in reduced tear film production and blink rate, loss of goblet cells, exfoliation of epithelial cells, intracellular oedema, and impairment of epithelial healing.
