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Ophthalmology SB > Systemic Disease and the Eye > Flashcards

Systemic Disease and the Eye Flashcards

(67 cards)

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1
Q

what are the features of neuro-ophthalamic disease

A

Eye movement defects – double vision

Visual defects - visual acuity, field loss

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2
Q

Ix of eye when trying to discover systemic cause

A

MRI

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3
Q

what is the most common systemic disease that has an effect on the eyes

A

Vascular disease

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4
Q

what is the most common nerve palsy

A

VIth nerve palsy

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5
Q

what happens in a VIth nerve palsy

A

Lateral Rectus stops working and cannot abduct eye.

Eye stuck in adduction as medial rectus works unopposed

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6
Q

what can cause a VIth nerve palsy

A

Microvascular; tend to be a few capillaries getting blocked in this case. Only knocking out one nerve. Usually resolve in a few months.

Raised Intracranial pressure
Tumour
Congenital

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7
Q

sudden onset 6th nerve palsy + headache = ?

A

raised intracranial pressure

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8
Q

what would be seen with raised intracranial pressure

A

bilateral papilloedema

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9
Q

what is the second most common nerve palsy that is mostly due to congenital problems

A

IVth nerve palsy

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10
Q

what muscle stops working in IVth nerve palsy

A

Superior Oblique

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11
Q

what are the functions of the SO muscle

A

intorsion
depression in adduction
abduction (weak)

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12
Q

what is a sign seen in IV nerve palsy

A

head tilt

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13
Q

what can cause IV nerve palsy

A

Congenital decompensated
Microvascular
Tumour
Bilateral – closed head trauma

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14
Q

what are clinical features of IV nerve palsy

A

torsion

chin depressed

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15
Q

what can cause a IIIrd nerve palsy

A 
Microvascular (most common)
Tumour
Aneurysm (surgical emergency - classical cause for acute emergency palsy)
MS
Congenital
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16
Q

how can you differentiate a 3rd nerve palsy caused by an aneurysm

A

Painful + Dilated pupil

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17
Q

what is Inter-nuclear Ophthalmoplegia

A

eye shows impairment of adduction

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18
Q

what happens in INO

A

When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally, if at all. The contralateral eye abducts, however with nystagmus. Additionally, the divergence of the eyes leads to horizontal diplopia. That is, if the right eye is affected the patient will “see double” when looking to the left, seeing two images side-by-side.

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19
Q

what are common causes of INO

A

MS

Vascular

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20
Q

what can affect the optic nerve

A 
Ischaemic Optic Neuropathy
Optic neuritis – commonly MS
Tumours - rare
-Meningioma
-Glioma
-Haemangioma
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21
Q

what are symptoms of optic neuritis

A

Progressive visual loss (unilateral)
Pain behind eye, especially on movement
Colour desaturation
Central scotoma (gap in visual field)

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22
Q

Tx of optic neuritis

A

Prednisone
OR
leave alone - gradual recovery, weeks to months

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23
Q

what can occur after optic neuritis

A

optic atrophy

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24
Q

what can affect the optic chiasm

A

Pituitary tumour
Craniopharyngioma; very rare, affects children
Meningioma

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25
what does a tumour at the optic chiasm cause
Bi-temporal field defect
26
what would the investigation of suspected tumour at optic chiasm be
MRI
27
vision loss is commonly reversed after tumour is removed from pituitary - true or false
True
28
what can affect the optic tracts
Tumours (primary or secondary) Demyelination Vascular anomalies
29
what does problems in the optic tracts cause
Homonomous defects Macula not spared Quadrantanopia
30
what can affect the occipital cortex
``` Vascular disease (CVA) Demyelination ```
31
what does problems at the occipital cortex cause
Homonomous defect | Macular sparing
32
what is seen in an eye affected by diabetic retinopathy
vascular occlusion >> proliferative retinopathy vitreous haemorrhage cotton wool spots hard exudates Intra-retinal microvascular abnormailities (IRMA) Dot + Blot haemorrhages Flame shaped haemorrhages tortuous veins
33
what does vascular occlusion cause
ischaemia +/- new vessels in the retina, optic disc and iris i.e. proliferative retinopathy cotton wool spots (ischaemic nerve fibres)
34
what happens when these new vessels bleed in proliferative retinopathy
vitreous haemorrhage
35
what does diabetic retinopathy changes put the eye at risk to
retinal detachment
36
what causes dot/blot/flame haemorrhages
dots - micro-aneurysm blot + flame - haemorrhages
37
how can diabetic patients lose vision
from: - retinal oedema affecting the fovea - vitreous haemorrhage - scarring/ tractional retinal detachment
38
what are the classifications of diabetic eye disease
Classification 1: non-proliferative retinopathy Classification 2: proliferative retinopathy Classification 3: maculopathy
39
what are the features of NPR
``` dots haemorrhages/micro-aneurysm flamed shape/blots haemorrhages hard exudates engorged to tortuous veins cotton wool spots ```
40
what are features of proliferative retinopathy
same as NPR BUT with new vessels appearing on optic disc and retina can cause vitreous haemorrhage
41
what is seen in maculopathy
oedema of optic disc | can threaten sight
42
how do hard exudates appear on fundoscopy
yellow patches
43
Mx of diabetic retinopathy
Optimise medical management Laser - proliferative retinopathy - pan retinal laser - Maculopathy - grid or focal laser treatment Surgery – vitrectomy to treat vitreous haemorrhage
44
how is diabetic macular oedema treated
Intravitreal Triamcinolone Anti-VEGF drug along with laser treatment
45
what can occur as a complication of diabetic retinopathy
CN III or VI palsy
46
what are features of hypertensive retinopathy
``` Attenuated blood vessels-copper or silver wiring cotton wool spots hard exudates flame haemorrhage optic disc oedema ```
47
what is amaurosis fugax
emboli to the retina causes a 'curtain passing across the eyes'
48
what are Roth spots
retinal infants of infective endocarditis
49
how does central retinal artery occlusion present
Sudden painless loss of vision very profound loss of vision retina appears white with a 'cherry red' spot at the macula rarely recovers
50
how does central retinal vein occlusion present
Sudden painless visual loss Range of visual loss- from profound to reasonably okay need to determine degree of ischaemia - correlates to degree of reduced vision and fundal appearances
51
in diabetes, what can make retinopathy worse
``` pregnancy dyslipidaemia increase BP renal disease smoking anaemia ```
52
how does a branch vein occlusion differ in presentation
unilateral vision loss Painless disturbance in vision may be assymptomatic may be aware of loss of part of field - branch affect correlates with division of vision lost
53
how does the retina appear in the different occlusions
artery occlusion - retina very pale, white vein - blood builds up, very dark
54
what can happen as a result of a vein occlusion
retinal ischaemia >> VEGF released >> new retinal vessel formation
55
how is neovasculation treated
laser photocoagulation
56
what are infective inflammatory diseases that can cause uveitis
``` TB Herpes Zoster Toxoplasmosis Candidiasis Syphilis Lyme Disease ```
57
what are non-infective inflammatory diseases that can cause uveitis
Idiopathic Juvenile Arthritis Sarcoidosis Behcet’s Disease
58
what eye condition is RA associated with
scleritis
59
what is PMR associated with that can cause blindness
Giant Cell Arteritis
60
what can GCA present with
headache jaw claudication malaise raised PV
61
what eye conditions are seen in SLE
Conjunctivitis | Episcleritis
62
what eye conditions are seen in RA
Dry eyes (Keratoconjunctivitis Sicca) Scleritis Corneal melt
63
triad seen in Sjogren's syndrome
- keratoconjunctivitis sicca - xerostomia (dry mouth) - Rheumatoid Arthritis (usually)
64
Ix for suspected Sjogren's syndrome in relation to the eyes
Schirmer test
65
Tx for Sjogren's
Pilocarpine and Cevimeline - dry mouth | Ciclosporin - dry eyes
66
eye features of Stevens-Johnson syndrome
Symblepharon occlusion of lacrimal glands corneal ulcers
67
what is Symblepharon
partial or complete adhesion of the palpebral conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball

Ophthalmology SB (7 decks)

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