the eye and systemic disease

Question 1

what is thyroid eye disease

Answer 1

Autoimmune disease caused by the activation of orbital fibroblasts by autoantibodies directed against thyroid receptors

Question 1

what is the most common association with thyroid eye disease

Answer 1

graves disease

Question 1

what characterises thyroid eye disease

Answer 1

enlargement of the extraocular muscles, fatty and connective tissue volume

Question 1

state the 5 main stages of thyroid eye disease

Answer 1

1. soft tissue involvement
2. lid retraction
3. proptosis
4. optic neuropathy
5. restrictive myopathy

Question 1

complication of proptosis in thyroid eye disease

Answer 1

exposure keratopathy leading to corneal ulceration

Question 1

what is the most common cause of proptosis

Answer 1

thyroid eye disease

Question 2

management of thyroid eye disease

Answer 2

steroids
lubricant
stop smoking !!

Question 3

what is vortex keratopathy

Answer 3

deposition of medications in the corneal epithelium

Question 4

drug most associated with vortex keratopathy

Answer 4

amiodarone

Question 5

drug most associated with bullseye maculopathy

Answer 5

chloroquine

Question 6

consequence of steroids on the eye

Answer 6

increased intraocular pressure

Question 7

what is Symblepharon

Answer 7

adhesions or fusions between the conjunctiva and the cornea

Question 8

name a drug associated with symblepharon

Answer 8

penicillin

Question 9

what does the 3rd cranial nerve supply in the eye (6)

Answer 9

medial rectus
inferior rectus
superior rectus
inferior oblique
sphincter pupillae
levator palpebrae superioris

Question 10

clinical sign of 3rd nerve palsy

Answer 10

eye down and out
may also cause ptosis and miosis

Question 11

what causes ptosis in 3rd nerve palsy

Answer 11

lack of innervation to levator palpebrae superioris

Question 12

what causes miosis in 3rd nerve palsy

Answer 12

loss of parasympathetic innervation to the sphincter pupillae muscle

Question 13

what does painful 3rd nerve palsy indicate

Answer 13

aneurysm

Question 14

what can cause bilateral 4th nerve palsy

Answer 14

closed head trauma

Question 15

what does cranial nerve 4 supply in the eye

Answer 15

superior oblique muscle

Question 16

clinical presentation of 4th nerve palsy

Answer 16

affected eye turned upward in primary position
vertical diplopia when looking inferiorly

Question 17

what is the most common acute nerve palsy

Answer 17

6th cranial nervee

Question 18

what does the 6th cranial nerve supply in the eye

Answer 18

lateral rectus muscle

Question 19

clinical presentation of 6th nerve palsy

Answer 19

horizontal diplopia worsened when looking towards the affected side

Question 20

state the main cause of 6th nerve palsy

Answer 20

raised intercranial pressure

Question 21

state the 2 main causes of 4th nerve palsy

Answer 21

congenital, trauma

Question 22

name 4 causes of visual field defects

Answer 22

vascular disease, space occupying lesion, demyelination, trauma

Question 23

causes of optic nerve defect (3)

Answer 23

ischaemic optic neuropathy optic neuritis - MS tumours - meningioma, glioma, haemangioma

Question 24

clinical presentation of an optic nerve defect

Answer 24

unilateral visual loss

Question 25

name some causes of an optic chiasm defect (3)

Answer 25

pituitary tumour, craniopharyngioma, meningioma

Question 26

field defect seen in obstruction to the optic chiasm

Answer 26

bitemporal field defect

Question 27

state 3 causes of optic tract and radiation defects

Answer 27

tumours, demyelination and vascular anomalies

Question 28

visual field defect seen in obstruction to the optic tracts

Answer 28

contralateral homonymous hemianopia

Question 29

visual field defect seen in obstruction to the optic radiations

Answer 29

contralateral homonymous quadrantopia

Question 30

is the macula spared in defects involving the optic tracts and radiations

Answer 30

no

Question 31

name 2 causes of field defects associated with the optic cortex

Answer 31

vascular disease, demyelination

Question 32

field defect seen in damage to the optic cortex

Answer 32

contralateral homonymous hemianopia with macular sparing

Question 33

scanning used to investigate visual field defects

Answer 33

MRI

Question 34

what is myotonia

Answer 34

inability to relax after muscle contraction

Question 35

mutation associated with myotonic dystrophy type 1

Answer 35

AD mutation in dystrophia myotonica protein kinase gene DMPK

Question 36

mutation associated with type 2 myotonic dystrophy

Answer 36

abnormally expanded section in ZNF9 gene

Question 37

clinical presentation of myotonic dystrophy (4)

Answer 37

muscle wasting and weakness mournful facial expression slurred speech frontal baldness in males

Question 38

name 3 common ocular manifestations of myotonic dystrophy

Answer 38

early onset cataract, ptosis, hypermetrophia

Question 39

cataract associated with myotonic dystrophy

Answer 39

stellate posterior cortical cataract

Question 40

name 4 uncommon ocular manifestations of myotonic dystrophy

Answer 40

mild ophthalmoplegia pupillary light-near dissociation pigmentary retinopathy optic atrophy

Question 41

2 ocular features of neurofibromatosis type 1

Answer 41

optic glioma lisch nodules

Question 42

clinical presentation of an optic glioma

Answer 42

globe proptosis and afferent pupillary defect

Question 43

what are lisch nodules

Answer 43

bilateral yellow or brown dome-shaped nodules

Question 44

what is dermatomyositis

Answer 44

an autoimmune condition that causes skin changes and muscle weakness

Question 45

name a drug that can cause dermatomyositis

Answer 45

hydroxyurea

Question 46

main ocular feature of dermatomyositis

Answer 46

heliotrope rash on eyelids

Question 47

inheritance seen in marfans syndrome

Answer 47

autosomal dominant mutation of the fibrillin-1 gene

Question 48

what is the main ocular feature of marfans syndrome

Answer 48

dislocated lens

Question 49

name some non-ocular features of marfans

Answer 49

tall, thin stature arachnodactyly narrow high-arched palate pectus excavatum dilated aortic root

Question 50

name 2 ocular features of rheumatoid arthritis

Answer 50

scleromalacia perforans peripheral ulcerative keratitis

Question 51

ocular feature of sjorgrens syndrome

Answer 51

punctuate epithelia erosions seen using fluorescein

Question 52

state 3 conditions in which granulomatous anterior uveitis is seen

Answer 52

sarcoidosis TB syphillis

Question 53

state 2 conditions in which we see posterior synechiae

Answer 53

HLA B27 and idiopathic anterior uveitis

Question 54

what are the 2 main classifications of diabetic retinopathy

Answer 54

proliferative and non-proliferative

Question 55

clinical presentation of non-proliferative diabetic retinopathy (4)

Answer 55

- microaneurysms - hard exudates - intraretinal haemorrhages - cotton wool spots - caused by ischaemia

Question 56

clinical presentation of proliferative diabetic retinopathy (2)

Answer 56

neovascularisation vitreous haemorrhage and traction

Question 57

name another eye complication of diabetes

Answer 57

diabetic macular oedema

Question 58

management of macular oedema

Answer 58

anti-VGEF laser therapy for clinically significant oedema vitrectomy used when signs of traction

Question 59

management of proliferative diabetic retinopathy

Answer 59

panretinal photocoagulation