The eye in systemic disease

Question 1

Presentationof CN VI palsy?

Answer 1

Can’t abduct the eye

Question 2

Causes of CN VI palsy

Answer 2

Microvascular
Raised ICP
Tumour
Congenital

Question 3

Presentation of CN IV palsy

Answer 3

wEAK DEPRESSION IN ADDUCTION

Question 4

Clinical features of bilateral IV palsy

Answer 4

ToRsion

Chin depressed

Question 5

Cause of bilateral CN IV palsy

Answer 5

Blunt head trauma

Question 6

Causes of CN IV palsy

Answer 6

Congenital decompensated
Microvascular
Tumour

Question 7

Presentation of CN III palsy

Answer 7

Down & out

Question 8

Causes of CN III palsy

Answer 8

Microvascular 
Tumour 
Aneurysm 
MS 
Congenital

Question 9

What causes a painful CN III palsy?

Answer 9

Aneurysm

Question 10

Causes of inter-nuclear opthalmoplegia

Answer 10

MS
Vascular
Lots of small print

Question 11

What is inter-nucleur opthalmoplegia?

Answer 11

When patients eyes are directed away from the side of the lesion the affected eye will not move past the midline and the non-affected eye will have nystagmus

Question 12

Causes of visual field defect

Answer 12

Vasclar disease
Scape occupying lesion
Demyelination (MS)
Trauma

Question 13

Who is optic neuritis common in?

Answer 13

MS patients

Question 14

What tumours can affect the optic nerve?

Answer 14

Meningioma
Glioma
Haemangioma

Question 15

Presentation of optic neuritis

Answer 15

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

Question 16

What can cause compression on the optic chiasm?

Answer 16

Pituitary tumour
Craniopharyngioma
Meningioma

Question 17

What causes bitemporal field defect?

Answer 17

Optic chiasm compression

Question 18

Is visual loss or disturbance permanent with a pituitary tumour?

Answer 18

It is commonly reversed after the tumour is decompressed or removed

Question 19

WHat can affect the occipital cortex?

Answer 19

Vascular disease (CVA) 
Demyelination

Question 20

Pathogenesis of diabetic retinopathy

Answer 20

Chronic hyperglycaemia
Glycosylation of protein/basement membrane
Loss of pericytes
microanuerysm
Microaneurysm can lead to leakage & ischaemia

Question 21

Signs of non-proliferative retinopathy on fundoscopy

Answer 21

Microaneurysms/ dot & lot haemorrhages 
Hard exudate 
Cotton wool patches 
Aormalities of venous calibre 
Intra-retin

Question 22

In what stages do new vessels grow in diabetic retinopathy?

Answer 22

Grow on disc
Grow in the periphery
Grow on iris if ischaemia is severe

Question 23

What can cause diabetics to lose vision?

Answer 23

Retinal oedema
Vitreous haemorrhage
Scarring/tractional retinal detachment

Question 24

How is diabetic retinopathy classified?

Answer 24

Mild
Moderate (non-proliferative retinopathy)
Severe (non-proliferative retinopathy)
Proliferative retinopathy

Question 25

How is diabetic maculopathy classified?

Answer 25

No maculopathy Observable maculopathy Referable maculopathy Clinically significant maculopathy

Question 26

Management of diabetic retinopathy

Answer 26

Optimise medical management Laser Vitrectomy Rehabilliatation

Question 27

Features of hypertensive retinopathy on fundoscopy

Answer 27

``` Atenuated blood vessels/ copper or silver wiring Cotton wool spots Hard exudates Retinal haemmorhage Optic disc oedema ```

Question 28

How does accelerated hypertension tend to present?

Answer 28

Particularly in young patients Very dramaic fundal appearance Can have decreased vision

Question 29

Presentation of central retinal artery occlusion

Answer 29

Sudden painless loss of vision Very profound loss of vision Retinal nerve fibre layer becomes swollen except at fovea (cherry red spot)

Question 30

Presentation of central retinal vein occlusion

Answer 30

Sudden pailess visual loss range of visual loss Ischaemia correlates to degree of reduced vision and fundal appearances

Question 31

How does a branch vein occlusion present?

Answer 31

Painless disturbance in vision May be assymptomatic May be aware of loss of part of field

Question 32

Infective causes of uveitis

Answer 32

``` TB Herpes Zoster Toxoplasmosis Candidiasis Syphilis Lyme disease ```

Question 33

Non-infective causes of uveitis

Answer 33

``` Idiopathic syndromes HLA-B27 Juvenile Arthritis Sarcoidosis Behcet's disease ```

Question 34

Presentation of GCA

Answer 34

``` PMR Headache Jaw claudication Malaise Raised P.V. Blinding condition ```

Question 35

Extraocular features of thyroid eye disease

Answer 35

``` Proptosis Lid retraction Lid oedema Lid lag Lid pigmentation Restrictive myopathy ```

Question 36

What is chemosis?

Answer 36

Oedema of the conjunctiva

Question 37

Ocular features of thyroid eye disease

Answer 37

``` Chemosis Injection Exposure Glaucoma Choroidal folds Optic nerve swelling ```

Question 38

What is the most common cause of unilateral and bilateral proptosis

Answer 38

Thyroid eye disease

Question 39

How is thyroid eye disease treated?

Answer 39

Control of thyroid dysfunction Lubricants Surgical decompression Smoking

Question 40

What efect can SLE have on the eyes?

Answer 40

Ocular inflammation

Question 41

What effect can RA have on the eyes?

Answer 41

Dry eyes Scleritis Corneal melt

Question 42

What is the triad of Sjogren's syndrome?

Answer 42

Keratoconjunctivitis sicca Xerostomia RA

Question 43

Ocular features of Steven-Johnson syndrome

Answer 43

Symblepharon Occlusion of lacrimal glands Corneal ulcers