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Ophthalmology > Ocular Manifestations of Systemic Disease > Flashcards

Ocular Manifestations of Systemic Disease Flashcards

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1
Q

Inflammatory Eye Disease Sx

A

Red eye
Dull ache
Photosensitivity
Intact corneal epithelium (no fluorescein staining)

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2
Q

Inflammatory Eye Disease Management

A

Ophtho referral for steroid management
Usually idiopathic - warrants rheumatological workshop
Management of complications (cataracts –> surgery, glaucoma –> drops and surgery, vitritis and epiretinal membranes –> surgery)

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3
Q

Infant Anterior Uveitis

A

TORCH infections, retinoblastoma

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4
Q

Child Anterior Uveitis

A

JIA, toxocariasis, toxoplasmosis

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5
Q

Young adult Anterior Uveitis

A

HLA-B27, Fuchs heterochromic iridocyclitis, pars plainitis, idiopathic endogenous infection

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6
Q

Elderly Anterior Uveitis

A

Lymphoma, serpiginous choroidopathy, vitiliginous choroiditis, ARN, post-op infection

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7
Q

Female Anterior Uveitis

A

JIA, SLE

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8
Q

Male Anterior Uveitis

A

Ankylosing Spondylitis, reactive arthritis

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9
Q

Caucausian Anterior Uveitis

A

HLA-B27, MS, white dot syndrome

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10
Q

African American Anterior Uveitis

A

Behcet disease

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11
Q

Asian, Native American Anterior Uveitis

A

VKH syndrome

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12
Q

Inflammatory Anterior Disease

A 
Rheumatoid Arthritis
Wegener's Granulomatosis
p-ANCA vasculitides
Systemic Lupus Erythematosis
Sarcoidosis
HLB-B27 Disease--> More common in WI (psoriatic arthritis, inflammatory bowel disease, reactive arthritis, ankylosing spondylitis)
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13
Q

Inferior Corneal Melting/Rheumatoid Arthritis Management

A

Amniotic membrane replacement
Lateral tarsorraphy v. shield @ all times
Doxycycline-collagenase inhibitor
Vitamin C 1000 mg/day
Suppress systemic immune-mediated inflammation (epithelium intact?–>prednisone drops 6x/day; might start w/ 60-80mg prednisone; Immunomodulator)

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14
Q

Inflammatory Posterior Disease

A 
Rheumatoid arthritis
Granulomatosis w/ polyangitis (Wegener's)
p-ANCA vasculitis (churg-strauss)
Multiple Sclerosis
Sarcoidosis
Pars planitis
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15
Q

Lupus Vasculitis

A

Inflammatory Posterior Disease
Causes: Conjunctivitis, Cotton wool ischemic spots, Cerebral involvement

Develops over a couple of weeks

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16
Q

Temporal Arteritis

A

aka Giant Cell arteritis
Elevated ESR/CRP/platelets
Tx: High dose steroids, sometimes IV, temporal artery biopsy
Rare in people < 70yo.

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17
Q

Optic Neuritis/MS

A 
Intermediate uveitis
Typically Female 20s-40s
Pain w/ eye movement
APD
Decreased color vision
Pulfrich effect
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18
Q

Pulfrich effect

A

W/ swinging pendulum, pt perceives lateral movement as depth movement around horizontal equator. Due to affected eye perceiving motion slower than unaffected eye, causing depth perception phenomenon

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19
Q

Acute Thyroid Eye Disease

A

Signs: Eyelid swelling, conjunctival chemosis
Sx: Pain, Double vision, vision loss, constricted visual fields, loss of color vision (fairly emergent)

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20
Q

Chronic Thyroid Eye Disease

A

Signs: Upper/lower lid retraction, Proptosis, Poor extra-ocular movements
Sx: Exposure and dryness, double vision

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21
Q

Thyroid Eye Disease

A

Orbit: Reduced Volume, orbital fat expansion
Muscles: Hypertrophy of EOC muscles
Lids: Retractor muscle hypertrophy similar to rectus muscles, Lids pulled back

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22
Q

Thyroid Eye Disease Diagnosis/tests

A

TSH/Free T4 levels
Maintain euthyroid state
Optic nerve assessment (pupils, color vision, visual fields)
Muscle assessment (EOM movements, Diplopia?)
Eyelids (measurement of retraction)

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23
Q

Thyroid Eye Disease Treatment

A

Lubricate cornea
Immunosuppression (Steroids, Rituxin, Radiation)
Surgery (Orbit, Muscles, Lids)

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24
Q

Neuroblastoma

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A

Unilateral black eye, poptosis and no trauma/suspicion of trauma
Dx: CT-Maxi face, adrenal masses w/ abd US, CT abd for adrenal masses

25
Eyelid and Orbital Lymphoma
Low grade B-cell lymphoma from MALT Orbit: Eylid mass, proptosis, 2/3 systemic Conjunctiva: Salmon pinkish patch, 1/3 sytemic
26
Eyelid and Orbital Lymphoma Mangement
Systemic Work up Biopsy Systemic: Chemo Local: Radiation
27
Intra-Ocular Lymphoma
Presentation: Chronic anterior uveitis, Posterior uveitis in elderly, Subretinal infiltrates Management: Vitreous Biopsy, Brain imaging, Lumbar puncture, Local or systemic chemo (Methotrexate, rituximab)
28
Metastasis
Most common malignancy in eye Breast (female) and lung (male) adenocarcinoma most common Uvea or orbit Poorly demarcated, multiple, bilateral
29
Retinoblastoma
Most common childhood eye cancer Early Detection --> Eye sparing treatment One eye w/o red reflex (large differential but consider retinoblastoma) Related to retinoblastoma tumor suppressor gene
30
Herpes Zoster Ophthalmicus
Caused by herpes zoster virus Lesions on nose = Hutchinson's Sign Affect the entire eye (all corneal layers, anterior/posterior uveitis, retina and optic nerve)
31
Herpes Zoster Ophthalmicus Management
Acyclovir, Valacyclovir | Refer in 3-5 days (or 1-2 days w/ pain/vision loss)
32
Herpes Simplex Virus
Dendritis keratitis Stromal keratitis Anterior uveitis Poster uveitis
33
Herpes Simplex Virus Management
Acyclovir, Valacyclovir | Refer to ophtho
34
Infectious Posterior Findings
``` Toxoplasmosis Syphilis Tuberculosis Lyme disease Toxocariasis ```
35
HIV/AIDS retinopathy
Ocular complications in 75% patients Retinal microangiopathy (cotton wool spots) Opportunistic infxns (CMV, pneumocystis, Toxoplasmosis, HZO) Tumors (Kaposi's sarcoma, Large cell lymphoma)
36
Infectious CMV Retinitis
CD4 counts < 40 Often asymptomatic w/o pain Starts in center or periphery but spreads ("brush-fire") 50% progress to retinal detachment
37
Infectius CMV Retinitis Tx
Systemic IV granciclovir or foscarnet Cidofovir Intravitreal granciclovir or foscarnet
38
Diabetic Retinopathy Risk Factors
``` #1: Duration of diabetes (Type 1 - refer @ year 5, Type 2 - refer @ onset) Blood sugar levels BP Hyperlipidemia/cholesterol Pregnancy Renal disease Anemia ```
39
DM Nonproliferative Diabetic Retinopathy (NPDR)
Retinal hemorrhages Hard exudates Mild/Moderate/Severe
40
DM Proliferative Diabetic Retinopathy
Neovascularization Vitreous hemorrhage Tractional retinal detachment
41
DM Macular Edema
Can occur @ any stage | LEADING CAUSE OF BLINDNESS IN DIABETIC PATIENTS
42
Mild/Moderate NPDR
Vascular disease causing ischemia and attempted to angiogenesis Yearly Dilated Fundus Exam (microaneurysms, hemorrhages, hard exudates, cotton wool spots)
43
Severe NPDR
Venous bleeding Dark hemorrhages Cotton-wool spots Intraretinal microvascular abnormalities (IRMA) Close follow up to watch for proliferative disease
44
Diabetic Macular Edema
Optical Coherence Tomography (OCT) - Light waves (like US) Fluorescein angiography: What's leaking? Intravitreal anti-VEGF therapy Laser treatment (focal to leaking microaneurysms, grid to diffuse leakage)
45
DM Proliferative Diabetic Retinopathy Tx
Pan-retinal photocoagulation (PRP) Observation, Vitrectomy Retinal attachment surgery
46
Hypertension
Can cause painless vision loss (acute onset macular edema, optic nerve damage) Management: Refer pts w/ vision loss, Control BP
47
Hypertensive Retinopathy
Arterial changes (narrowing, copper wiring, silver wiring) A/V crossing changes (90 degree angles, nicking) Retinal hemorrhages Retinal exudates (hard, macular star) Papilledema
48
Hypertension Macroaneurysms
Unlucky. | Congenital small aneurysms rupture w/ HTN --> poor vision
49
Ischemic Optic Neuropathy
HTN can cause | Lead to long-term vision damage
50
Central Retinal Arterial Occlusion (CRAO)
Unilateral painless acute vision loss Most common cause of cherry red spot Etiology: atherosclerosis, emboli, vasculitis, coagulopathy, collagen vasc disease, migraine IRRIVERSIBLE DAMAGE AFTER ~100 min.
51
CRAO Tx
ASA (tylenol) Ocular massage IOP reduction w/ acetazolamide Anterior chamber paracentesis Imaging: Carotid US, echo, MRI-brain
52
Retinal Vein Occlusion (RVO)
Sx: Blind spot in visual field, Loss of vision, Unilateral | Associated w/: Atherosclerosis, HTN, Diabetes, Age >50, Glaucoma
53
Central Retinal Vein Occlusion
Blood (Hemorrhage) and Thunder (Edema)
54
RVO Tx
``` Intravitreal anti-VEGF (avastin, lucentis, eylea) Grid laser (resistant BRVO) Intravitreal Steroid (Resistant CRVO) ```
55
Marfan's Syndrome
Inherited Bilateral lens subluxation (non-progressive, upward) Glaucoma Retinal detachment (secondary to lattice degeneration) Flat cornea Hypoplasia of dilators
56
Down's Syndrome
``` Inherited Cataracts Acute keratoconus Nasolacrimal duct obstruction-tearing Blepharitis Strabismus Nystagmus (10%) Iris Brushfield spots High refractive errors (hyperopia >> myopia) ```
57
Keratoconus
``` Ass w/ eye rubbing as child Corneal thinning (cone shape) ``` Tx: FDA approved cross-linking (stops progression), hard contact lens
58
Phacomatoses-Neurofibromatosis
``` Iris Lisch nodules Plexiform neurofibromas of eyelid Prominent corneal nerves Glaucoma Choroidal hamartomas 15% have low grade optic nerve astrocytoma (glioma) ```
59
Myotonic Dystrophy
long-term genetic disorder that affects muscle function frontal balding, cognitive challenge, long face, open mouth, weak distal extremities, foot drop, CHRISTMAS TREE CATARACTS Chromosome 19

Ophthalmology (9 decks)

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