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Flashcards in Systemic disease Deck (13)
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1

Blood pressure target

Keep below 150/85 mmHg

2

Main ocular problems in diabetes

Retinopathy and cataracts

3

Usual state of eyes at presentation of diabetes

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

4

What are the structural changes associated with diabetes

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

Pathogenesis of retinopathy

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

6

What does vascular occlusion in diabetic retinopathy lead to?

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

What does vascular leakage in diabetic retinopathy lead to?

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

Grading of diabetic retinopathy

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

9

What can accelerate diabetic retinopathy

Pregnancy
Dyslipidaemia
HTN
Renal disease
Smoking
Anaemia

10

Interventional treatment of diabetic eye disease

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

11

Medication treatment of diabetic eye disease

Intravitreal triamcinolone
Anti-vegF for macular oedema

12

CNS effects of diabetic eye disease

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

Side effects of panretinal photocoagulation

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