Systemic Disease And The Eye

Question 1

Surgical sieve of aetiologies of eye pathologies

Answer 1

Vascular - main one
Tumour
Trauma
Demyelination
Inflam/infection
Congenital

Question 2

Ix for CNVI nerve palsy

Answer 2

Cover test

Question 3

Causes of CNVI palsy

Answer 3

Microvascular (most common)
Raised ICP (false localising sign)
Tumour
Congenital

Question 4

Nerve responsible for intorsion- keeping eye straight when wiggle head

Answer 4

CNIV

Question 5

Clinical features of CNIV bilateral palsy

Cause of it -

Answer 5

Torsion and chin depressed

Blunt head trauma

Question 6

Causes of a CNIV palsy

Answer 6

Congenital decompensated (most common)
Microvascular
Tumour
Blunt head trauma (if bilateral)

Question 7

If pupil is involved in CNIII palsy then you must rule out ___

Answer 7

An aneurysm

Question 8

Causes of CNIII palsy

Answer 8

Microvascular (most common if pupil not involved)
Tumour
Aneurysm (if pupil involved)
MS
Congenital

Question 9

Common site of internuclear ophthalmoplegia

Answer 9

Medial longitudinal fasciculus

Between nuclei of CNIII and VI

Question 10

Causes of internuclear ophthalmoplegia

Answer 10

MS
Vascular
Demyelination
Stroke

Question 11

Optic nerve pathology:
complete visual field loss can be caused by ___
visual field loss that abides by the horizontal can be caused by ___

Answer 11

tumour compressing nerve

vascular causes

Question 12

optic neuritis of the optic nerve is commonly caused by

Answer 12

MS

Question 13

tumours of the optic nerve (these are rare)

Answer 13

glioma
meningioma
haemangioma

Question 14

4 features of optic neuritis

Answer 14

unilateral progressive vision loss
pain behind the eye esp on movement
colour desaturation
central stromata

Question 15

Rx for optic neuritis

Answer 15

none really - resolves over weeks/months

Question 16

Ix for optic neuritis and their appearance

Answer 16

MRI - inflamed optic nerve and maybe demyelination of white matter
fundoscopy - optic disc atrophy possibly - looks pale and featureless

Question 17

pathology that can affect the optic chiasm (3)

Answer 17

pituitary tumour
craniopharyngioma
meningioma

Question 18

pathologies of the optic tract and radiations cause what kinds of visual field losses

Answer 18

homonomous
macula not spared
quadrantanopia
incongruous

Question 19

optic tract and radiations can be affected by which pathological processes?

Answer 19

tumours
demyelination
vascular abnormalities

Question 20

optic cortex can be affected by which pathological processes?

Answer 20

vascular disease (CVA)
demyelination
abscess

Question 21

pathologies of the optic cortex cause what kinds of visual field losses

Answer 21

homonomous
macular spared
congruous

Question 22

microaneurysms are visible on ophthalmoscope when they are ___ in size

Answer 22

20microns

Question 23

signs of non-proliferative diabetic retinopathy

Answer 23

microaneurysms
dot+blot haemorrhages
hard exudate
cotton wool spots
 venous calibre abnormalities
IRMA

Question 24

signs of proliferative diabetic retinopathy

Answer 24

neovasculisation of the disc (NVD) or peripherally (NVE)

if severe ischaemia the rubeosis iridis

Question 25

rubeosis iridis =

Answer 25

neovasculisation of the iris - sign of severe ischaemia

Question 26

causes of loss of vision in diabetics

Answer 26

retinal oedema affecting the fovea vitreous haemorrhage acrring/tractional retinal detachment

Question 27

Rx for diabetic retinopathy

Answer 27

optimise diabetic management laser - PRP/macular grid (reduce demand) Sx (vitrectomy) rehab if blind/partially sighted

Question 28

features of hypertension in the eye

Answer 28

``` attenuated blood vessels (copper/silver wiring) cotton wool spots hard exudate retinal haemorrhage optic disc oedema ```

Question 29

___ spot is a feature of CRAO due to ___

Answer 29

cherry red spot | pink choroid shows through retina as the rest of the retinal nerve fibre layer becomes swollen except at the fovea

Question 30

___ in CRVO correlates to reduction in vision and fundal appearance

Answer 30

degree of ischaemia

Question 31

VEGF being pumped out to the iris if CRVO causes extensive ischaemia =>

Answer 31

rubeousis iridis

Question 32

BRVO => ____ disturbance of vision, may be ___

Answer 32

painless | asymptomatic

Question 33

2 classes of causes of uveitis and some examples

Answer 33

non-infective (Sarcoid, Behcets, Juvenile arthritis, ank spond, idiopathic) infective (tb, HZ, toxoplasmosis, candidiasis, syphilis, lyme disease)

Question 34

inflam of medium sized vessels ass with polymyalgia rheumatica

Answer 34

GCA

Question 35

ocular features of thyroid eye disease

Answer 35

ant segment - chemosis, injection, exposure, glaucoma | post segment - choroidal folds, optic nerve swelling

Question 36

multisystem immunological disease, anti DNA Ig, ocular inflam =

Answer 36

SLE

Question 37

RA can cause these 3 ocular problems

Answer 37

keratoconjunctivitis sicca, scleritis, corneal melt

Question 38

triad of Sjogren's

Answer 38

keratoconjunctivitis sicca xerostomia RA

Question 39

Sjogrens can cause infiltration of ___

Answer 39

lacrimal glands

Question 40

eye problems associated with Marfan's (4)

Answer 40

dislocated lens retinal detachment myopia pre-senile cataracts

Question 41

erythema multiforme, symblepharon, occlusion of lacrimal glands and corneal ulcers are all features of

Answer 41

Stevens-Johnson syndrome

Question 42

symblepharon =

Answer 42

adhesion of palpebral to bulbar conjunctiva

Question 43

lesion in left optic nerve causes what visual field defect

Answer 43

left monocular vision loss

Question 44

lesion in optic chiasm causes what visual field defects

Answer 44

bitemporal hemianopia

Question 45

lesion in left optic tract causes what visual field defect

Answer 45

right homonomous hemianopia

Question 46

lesion in left temporal lobe optic radiation causes what visual field defect

Answer 46

right homonomous superior quadrantanopia

Question 47

lesion in left parietal lobe optic radiation causes what visual field defect

Answer 47

right homonomous inferior quadrantanopia

Question 48

lesion in left occipital cortex visual area causes what visual field defect

Answer 48

right homonomous hemianopia with macular sparing

Question 49

why is the macula spared in occipital cortex visual area lesions

Answer 49

has a different blood supply