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Opthalmology > Systemic disease > Flashcards

Flashcards in Systemic disease Deck (13)
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1
Q

Blood pressure target

A

Keep below 150/85 mmHg

2
Q

Main ocular problems in diabetes

A

Retinopathy and cataracts

3
Q

Usual state of eyes at presentation of diabetes

A

Lens may have higher refractive index therefore relative myopia - this reduces with treatment therefore wait to correct refractive errors until diabetes is controlled

4
Q

What are the structural changes associated with diabetes

A

Accelerates productive and progress of age related cataracts - and in young (lens takes up glucose converted by aldolase reductase to sorbitol)
Also ischaemia can cause rubeosis, this can block drainage of aqueous leading to glaucoma

5
Q

Pathogenesis of retinopathy

A

Microangiopathy in small vessels of the eyes causes occlusion +/- leakage

6
Q

What does vascular occlusion in diabetic retinopathy lead to?

A

Ischaemia and new vessel formation - proliferative retinopathy
New vessels bleed = vitreous haemorrhage
Also retraction of retina fibres that run with new vessels risks retinal detachment
Also cotton wool spots (nerve ischaemia)

7
Q

What does vascular leakage in diabetic retinopathy lead to?

A

Pericytes lost
Vessels bulge - microaneurysms (dots)
There is oedema and hard exudates (yellow patches)
Rupture of these microaneurysms causes flame haemorrhages and when deep in the retina = blot haemorrhages

8
Q

Grading of diabetic retinopathy

A

Mild, moderate and severe non-proliferative (just signs of ischaemia)
Proliferative retinopathy
Maculopathy - leakage from vessels close to macula

9
Q

What can accelerate diabetic retinopathy

A
Pregnancy 
Dyslipidaemia
HTN
Renal disease
Smoking
Anaemia
10
Q

Interventional treatment of diabetic eye disease

A

Photocoagulation for maculopathy (focal or grid) and proliferative retinopathy (panretinal)

11
Q

Medication treatment of diabetic eye disease

A

Intravitreal triamcinolone

Anti-vegF for macular oedema

12
Q

CNS effects of diabetic eye disease

A

Ocular palsies may occur - typical CN III and VI

In CN III palsy pupil may be spared because nerve fibres run peripherally in nerve and receive alternate blood supply

13
Q

Side effects of panretinal photocoagulation

A

Does not improve vision only helps prevent blindness
May cause some loss of peripheral, colour and night vision
May get general blurring - usually transient but may persist