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Systemic Disease Flashcards

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0
Q

Ocular complications of diabetes can be reduced by

A

Early detection/monitoring
Good diabetic control
Modification of risk factors - blood sugars, lipids, blood pressure, stop smoking

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1
Q

Ocular complications of diabetes

A 
Diabetic retinopathy
Diabetic maculopathy
Extra-ocular muscle palsy
Retinal vascular occlusions 
Cataracts
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2
Q

Diabetic retinopathy

A

Characteristic retinal abnormalities that occur throughout the retina
Include retinal micro-haemorrhage, exudates (hard exudate are lipid deposits), cotton wool spots

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3
Q

Diabetic maculopathy

A

Characteristic macula abnormalities
Most commonly macula oedema, exudates, retinal thickening and ischaemia
Starts with slight central visual loss but is often progressive
Major cause of vision loss in diabetic retinopathy

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4
Q

Macula oedema is clinically significant, and should be treated if

A
  1. If there is retinal thickening/exudates within 1/3 optic disc diameters from the centre of the macula
  2. If there is one disc area of retinal thickening or more, part of which is within one disc area of the centre of the macula
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5
Q

Diabetic extra-ocular muscle palsy

A

Diabetes can cause an isolated 3rd, 4th or 6th nerve palsy with pain around the eye
Diabetic 3rd nerve palsy spares the pupillary function

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6
Q

Diabetes and cataracts

A

Posterior subcapsular cataracts are frequently seen in diabetics

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7
Q

Diabetic retinopathy - risk in diabetic patients

A

20yrs after diagnosis 95-100% type 1s and 60% of type 2s will show retinopathy
30 years after diagnosis 30% of type 1 and 3% type 2 will have proliferative disease

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8
Q

Proliferative disease (proliferative diabetic retinopathy)

A

new vessel growth in the disc and elsewhere in the retina

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9
Q

Loss of sight in diabetes can be due to

A 
Macula oedema
Macula ischaemia
Haemorrhage from new vessels
Tractional retinal detachment
Field loss due to laser treatment
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10
Q

Causes of diabetic retinopathy

A

Its due to hyperglycaemia
Clinical signs are due to small vessel occlusion, increased vascular permeability and changes in vessel walls die to loss of pericyte cells
Proliferative disease is caused by VEGF from ischaemic retina

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11
Q

Vitreous haemorrhage

A

Second most common cause of visual loss in diabetic retinopathy
Can cause acute vision loss and floaters

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12
Q

Retinal signs of diabetic retinopathy

A 
Micro-aneurysms
Dot & blot haemorrhages
Exudates & Cotton wool spots 
Retinal oedema and thickening
Neovascular and venous changes --> new vessels at the disc (NVD) and elsewhere (NVE)
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13
Q

Ocular ischaemia syndrome

A

A rare disease which occurs as a result of atherosclerotic vessels, generally the internal carotids.
The resulting ischaemia causes retinopathy and produces similar signs to diabetic micro vascular ischaemia

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14
Q

Investigating diabetic retinopathy

A

Duration and type of diabetes - HbA1c
Smoking
Other diabetes associated disease
Visual symptoms and past eye disease/treatment
Check red reflex for cataracts then dilated fundoscopy

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15
Q

Management of diabetic retinopathy

A

Screening of diabetic patients
Control diabetes and risk factors
Refer to ophthalmologist if - severe non-proliferative/proliferative retinopathy or maculopathy

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16
Q

Treatment of diabetic retinopathy

A

Classify the retinopathy - monitor. Treat any associated disease
PRP for new vessel growth,
Focal macula laser to reduce macula oedema, also Intravitreal anti-VEGF injections (ranibizumab) but multiple may be needed
Vitrectomy surgery is occasionally used for vitreous haemorrhage or relieve tractional retinal detachment

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17
Q

fluorescein angiography

A

Used to identify leaking new blood vessels and oedema

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18
Q

Classification of diabetic retinopathy

A

Mild non-proliferative DR -> Moderate non-proliferative DR ->
Severe non-proliferative DR -> Very severe non-proliferative DR ->
Non-high risk proliferative DR -> High risk proliferative DR -> Advanced proliferative DR -> Maculopathy

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19
Q

More recently UK ophthalmologists have started using

A 
A system like tumour grading
Retinopathy - R0, R1, R2, R3 or R4
Maculopathy - M0 or M1
Photocoagulation - P0 or P1
Unclassifiable - U
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20
Q

Thyroid eye disease - introduction

A

An inflammatory disease affecting the extra ocular muscle and the orbital connective tissues
There is an initial inflammatory stage followed by an inactive fibrotic state

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21
Q

Thyroid eye disease - epidemiology

Study These Flashcards
A

An idiopathic autoimmune disorder - usually associated with hyperthyroidism but can occur in normal or hypothyroid
Peak incidence at 30-50yrs, more common in women
Worst cases are smokers, males and older people
Can lead to sight threatening optic neuropathy or exposure keratopathy

22
Q

NOSPECS

Study These Flashcards
A

A classification of the severity of symptoms:

(1) No symptoms or signs (5) Extraocular muscle palsy
(2) Only lid retraction +- lid lag (6) Corneal disease
(3) Soft tissue involvement (7) Sight threatening optic
(4) Proptosis Neuropathy

23
Q

Thyroid eye disease - symptoms

Study These Flashcards
A

Conjunctival injection & redness
Dryness, watering
Photophobia, Visual loss & Diplopia

24
Thyroid eye disease - history
Smoking | Family history of thyroid eye disease
25
Thyroid eye disease - signs
Conjunctival inflammation/chemosis Upper lid retraction +- lid lag on looking down Proptosis and Lagophthalmos Reduced eye movements due to muscle palsies (inferior rectus) If severe - Exposure keratopathy and optic neuropathy
26
Proptosis
Forward bulging of the globe in the orbit
27
Lagophthalmos
Inability to completely close the lids
28
Exposure keratopathy
Drying of the inferior part of the cornea due to incomplete lid closure
29
Symptoms of optic neuropathy
Reduced visual acuity Reduced colour vision Visual field defects
30
Thyroid eye disease - Investigations
Thyroid function tests and TSH | CT of orbit if uncertain, or to check for optic nerve compression
31
Thyroid eye disease - management
Refer to endocrinologist to manage systemic thyroid disease Exposure keratopathy --> artificial tears Elevate the head at night if eyelid oedema is a problem May require systemic steroids --> must monitor IOP Radiation can be used if that doesn't work
32
Ocular symptoms of MS
Optic neuritis --> inflammation of the optic nerve is common symptom of MS visual field defects Cranial nerve palsies -> most commonly the 6th Nystagmus
33
Optic neuritis in MS
Dysfunction developing over hours/days - painful eye movement Variable reduction in visual acuity, Visual field defects & reduced colour vision (red desaturation because red vision goes first) Typically 18-45yrs Uhotoff's sign
34
Uhtoff's sign
Worsening of symptoms on exercise or increased body temperature --> symptoms are worse in the bath
35
Optic neuritis in MS - signs
RAPD Colour vision defect Visual field defect May have swollen optic discs --> may not if inflammation is further back --> retrobulbar optic neuritis
36
Optic neuritis in MS - investigations
Ask about - age, duration/nature of visual loss, previous episodes, pain on moving the eye Check for any other focal neurological signs
37
Optic neuritis in MS - management
Quantify deficit --> test pupils and eye movements, check level of red desaturation, confrontation visual field testing, fundoscopy Full neurological exam Refer to neurology --> MRI to confirm
38
Ocular problems in immunocompromised patients
Most commonly due to HIV --> varies with severity of compromise/infection CD4 count >1000cells/mL is normal, CD4 count <50 is very low with high risk of CMV retinitis or other infections
39
When seeing a patient with HIV about their eyes you should check
Acuity and function Eyelids and the external eye Dilated fundoscopy including the peripheral retina Ask about systemic illnesses and duration of HIV
40
CMV retinitis
Normally causes subacute infections in the salivary glands Ocular infections only in the immunocompromised On fundoscopy: Para-vascular (following the vessels) opacification with associated haemorrhage
41
Blepharitis
An eye condition characterised by chronic inflammation of the eyelid which is usually self-limiting Can be caused by staphylococcal species Presents with sticky debris at eyelash roots, secondary punctate corneal erosions and may have conjunctival hyperaemia
42
Mollescum contagiosum
A condition caused by a poxvirus infection causing a small eyelid nodule, mild mucoid discharge and an inferior fornix follicle Occurs in immunocompromised and immunocompetent patients Consider in cases of recurrent or refractory conjunctivitis
43
HIV retinopathy
A condition characterised by retinal possible micro-haemorrhages with cotton wool spots on fundoscopy A rare condition of unclear Pathophysiology
44
Toxoplasmosis of the retina
Common parasitic infection which is only active in the retina of immunocompromised patients On fundoscopy: dark areas of older disease and active disease appearing as white retinitis Spread by cats
45
Conjunctival kaposi sarcoma
A condition characterised by a red-violent nodule on the eyelid which is associated with HIV
46
Hypertensive retinopathy
Similar to hypertensive changes elsewhere in the body but easier to see A serious complication of uncontrolled hypertension
47
Hypertensive retinopathy - fundoscopy signs
cotton wool spots due to retinal ischaemia hard yellow lipid exudates, 'copper and silver wiring' flame haemorrhages in the retinal nerve fibre layer macro-aneurysms (red dots), macula oedema, optic disc swelling, venous nipping at arteriovenous crossings,
48
Symptoms of hypertensive retinopathy
Usually asymptomatic but can experience visual loss
49
Copper and silver wiring
A fundoscopy sign of hypertensive retinopathy Vessels have an altered reflex giving a different appearance A hard sign to detect in practice
50
Differential diagnosis for hypertensive retinopathy
Ask about control and measure blood pressure Diabetic retinopathy --> exclude by history and check BM Diabetic/hypertensive retinopathy look similar and can co-exist Consider Retinal vein occlusion
51
Hypertensive retinopathy - treatment
Control blood pressure
52
Hypertensive retinopathy - classifications
Grade 0 - normal Grade 1 - arteriolar narrowing Grade 2 - focal arteriolar narrowing + arteriovenous nipping Grade 3 - haemorrhages, exudates and cotton wool spots Grade 4 - grade 3 but with disc swelling

Ophthalomology (11 decks)

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