Systemic Disease and the Eye Flashcards
(36 cards)
What thyroid disease is associated with unique eye changes?
Grave’s Disease
What are the features of Grave’s Disease?
Proptosis
Lid Lag
Lid retraction
Exopthalmus
Why does Grave’s Disease cause eye changes?
Anti-bodies (also stimulate TSH receptors) cause inflammation of the extra-occular muscles and peri-robital tissues. This is an enclosed space and so causes the eye to protrude.
What may be seen on imaging of a patient with Grave’s eye disease?
Swollen extra-ocular muscles
Proptosis of the eye
Why is Grave’s eye disease concerning for ocular reasons?
Inflammation can cause blindness due to compression of the optic nerve. The orbit doesn’t permit expansion.
Corneal perforation- eye lids and tear film normally protect the cornea and sclera but when they are protruded this is not as possible which can lead to thinning and perforation of the cornea.
Why does Grave’s Disease cause corneal perforation?
Proptosis prevents proper closure of the eye lids. This normally protects the cornea and prevents drying out. Patients who cannot properly close their eyes are prone to their cornea drying out and perforating.
What worrying thing can cause a third nerve palsy?
PCA aneurysm-
May also have headache. Request a Cerebral Angiogram
What eye symptoms can myasthenia gravis cause?
Drooping eye lid
Double vision
Decreased ROM
What are the features of Horner’s Syndrome?
Meiosis (constricted pupil)
Ptosis
Anhydrosis
(Different size of pupils evident in low light)
What causes Horner’s syndrome?
Compression of the sympathetic chain anywhere along it’s root.
Apical lung carcinoma
Carotid Aneurysm/ dissection
How might cardiovascular disease cause ocular issues?
Hypertensive retinopathy Central artery occlusion Central vein occlusion (Or branches of above) Amaurosis Fugax Anterior ischaemic optic neuropathy
What association is there in ophthalmology with sero-negative arthropathies?
Sero-negative arthropathies are associated with anterior uveitis (inflammation of iris). These are the ones that are HLA-B27 positive a lot of the time.
What rheumatology condition is a cause of dry eyes?
Sjogren’s disease
What condition must be ruled out with anterior ischaemic optic neuropathy?
Giant Cell Arteritis
What is episcleritis? Is it painful?
Bleeding and inflammation in the outer sclera. Unlike conjunctivitis this is segmentally red. It is not painful.
What is scleritis? Is it painful?
Scleritis is very painful
It is the inflammation of the sclera
It is dilation of deeper blood vessels than episcleritis (non-painful)
Can also be posterior so not visible initially.
What is a condition is scleritis and episcleritis associated with?
Rheumatoid arthritis
What is a corneal melt?
Cornea thins due to inflammation
Can progress to corneal perforation and requires high dose systemic immunosuppression (e.g. steroids)
What is a posterior synechiae? What condition may it occur with?
Iris adheres to the anterior surface of the lens due to inflammatory exudate in anterior uveitis
When the iris attempts to dilate it cannot due to adhesions
What features are seen with Behcets Disease?
Oral ulcers with 2 of:
Recurrent genital ulceration
Skin lesions- folliculitis, erythema nodosum
Positive pathergy test- pustular reaction after pricking the skin with a needle
Eye involvement- Acute anterior uveitis, vitritis, vasculitis, retinitis (Eye disease is seen in 75%)
What is the treatment for Behcet’s Disease?
Immunosuppression
What may be seen in acute anterior uveitis?
Redness
Hypopyon- inflammatory material in anterior chamber
Reduced clarity of cornea
Corneal infiltration
What condition is temporal arteritis associated with?
PMR
What is blepharitis? What symptoms does it cause?
Disorder of the meibomian glands that causes inflammation of the lid margin when the glands become obstructed. This can cause a sensation of gritty eye and dry eye.
