Systemic Disease in the eye

Question 1

In a fundoscopy what would someone with poorly controlled diabetes have?

Answer 1

Microaneurysms
Hard Exudate
Haemorrhage
Cotton wool Patches
Swollen optic disc

Question 2

What is the driving force behind an increased production of VEGF?

Answer 2

Ischaemia

Question 3

New vessel growth occuring here has the worst prognosis for vision loss.

Answer 3

Optic disc

Question 4

What is Rubeosis Iridis?

Answer 4

New vessel growth over the iris.

Endstage disease involving VEGF

Question 5

What is seen in the eye of someone with uncontrolled hypertension?

Answer 5

Cotton wool exudates
Disk Swelling - loss of the margin
Thining of blood vessel
Haemorrhage

Question 6

What does the cornea of someone with Sarcoidosis look like?

Answer 6

Granulomatous Uveitis

Patchy white spots on the underside of the cornea

Question 7

How does Giant Cell Arteritis present?

Answer 7

Headache
Jaw Claudification
Malaise
Visual Distrubances

Question 8

What disease is GCA associated with?

Answer 8

Polymyalgia Rheumatica

Question 9

How does thyroid eye disease present extraocularly?

Answer 9

Proptosis
Lids -Retraction Oedema Lag
Restrictive Myopathy - eye moves slower

Question 10

How does thyroid eye disease present in the eye?

Answer 10

Chemosis 
Glaucoma
Exposure abrasions
Choroidal folds
Optic nerve swelling

Question 11

What is the treatment for thyroid eye disease?

Answer 11

Control thyroid dysfunction
Surgical decompression
Lubricants

Question 12

What antibody is related to SLE ?

Answer 12

Anti DNA Ab

Question 13

How does SLE present in the eye?

Answer 13

Scleritis

Painful to move

Question 14

How does rheumatoid arthritis present in the eye?

Answer 14

Dry eyes
Scleritis
Corneal melting

Question 15

What is the classic triad of Sjogrens?

Answer 15

Dry eye
Dry mouth
Rheumatoid Arthitis

Question 16

Why does someone with Sjogrens present with a dry eye?

Answer 16

The lacrimal gland is affected

Question 17

How do people with Marfans present?

Answer 17

Superiorly dislocated Lens
High Arched Palate
Tall

Question 18

How does erythema multiform present?

Answer 18

Maculopapular Rash
Stomatitis
Conjunctivitis
Scarring of the conjunctiva
Occlusion of the lacrimal duct.

Question 19

How is erythema multiform triggered?

Answer 19

Food Drug or post infection hypersensitivity reaction.

Question 20

What nerve innervates the lateral rectus?

Answer 20

Cranial Nerve 6

Abducens

Question 21

If someone has a CN VI palsy how do they present?

Answer 21

Eye sits more medially

Horizontal diplopia

Question 22

List some causes of a CN VI palsy.

Answer 22

Microvascular 
Raised ICP
Tumour
Congenital
Demyelination- MS

Question 23

If this presents alongside a CN VI palsy what happens?

Answer 23

Papilloedema

If present its a medical emergency.

Question 24

What cranial nerve supplies the Superior Oblique?

Answer 24

CN IV

Trochlear

Question 25

Why is the trochlear nerve particularly susceptible to closed ear trauma?

Answer 25

As it originates from the back of the brain and has to work its way around to the front this long route is particularly susceptible to compression damage.

Question 26

How does someone with a CN IV nerve palsy present?

Answer 26

Vertical diplopia Depression in adduction Look for classic head tilt

Question 27

List some common causes of a CN IV nerve palsy.

Answer 27

Congenital weak SO Microvascular Tumour Closed head trauma

Question 28

What does CN III supply?

Answer 28

``` Levator Palpebrae Superiosis Sphincter Pupilla Medial rectus Superior rectus Inferior Rectus Inferior oblique ```

Question 29

How does someone with a CN III palsy present?

Answer 29

Only get Adduction and depression from SO and LR

Question 30

What is general rule with a suspected CN III palsy?

Answer 30

Suspect aneurysm till proven otherwise

Question 31

If someone with a CN III palsy presents with a dilated pupil what does this mean?

Answer 31

Compression pathology e.g. aneurysm

Question 32

If the CN III palsy is due to microvascular pathology what is likely to be seen?

Answer 32

No pupil involvement

Question 33

What is involved in inter nuclear ophthalmoplegia?

Answer 33

A coordination issue, communication between each eye is faulty. Eyes don't work in symmetry

Question 34

What is involved in supra nuclear ophthalmoplegia ?

Answer 34

A coordination issue, this time between the eyes and the rest of the brain. Balance issues etc