The Eye in Systemic Disease

Question 1

What is the biggest cause of visual loss in the working population?

Answer 1

Diabetic retinopathy

Question 2

Chronic hyperglycaemia results in the formation of what in diabetic retinopathy? What does this lead to?

Answer 2

Microaneurysm, which leads to leakage and ischaemia

Question 3

What is meant by proliferative retinopathy?

Answer 3

New vessels start to form

Question 4

What are some signs of non-proliferative retinopathy?

Answer 4

Microaneurysms (dot and blot haemorrhages), hard exudate, cotton wool patches, venous and microvascular abnormalities

Question 5

Non-proliferative retinopathy can be divided into what?

Answer 5

Mild, moderate and severe

Question 6

Where can new vessels grow in diabetic retinopathy?

Answer 6

On the disc (NVD), on the periphery (NVE) and very rarely on the iris

Question 7

Why do diabetic patients lose vision?

Answer 7

Retinal oedema affecting the fovea, vitreous haemorrhage, retinal detachment

Question 8

What are the 4 stages of diabetic maculopathy?

Answer 8

None, observable, referable, clinically significant

Question 9

What are the management options for diabetic retinopathy?

Answer 9

Optimising diabetic control, laser treatments, vitrectomy, rehabilitation

Question 10

In hypertensive retinopathy, the appearance of the fundus correlates to what?

Answer 10

The severity of the hypertension and the state of the retinal arterioles

Question 11

Which patients with hypertensive retinopathy tend to have severe disease?

Answer 11

Young patients

Question 12

Who does accelerated hypertension occur in and what does it cause?

Answer 12

Occurs in young patients and causes a dramatic fundal appearance and decreased vision

Question 13

What condition does giant cell arteritis have an association with?

Answer 13

Polymyalgia rheumatica

Question 14

What characterises thyroid eye disease?

Answer 14

Swelling of the extraocular muscles and orbital fat

Question 15

What is the most common cause of unilateral and bilateral proptosis? What kind of condition is this?

Answer 15

Thyroid eye disease, autoimmune condition

Question 16

What is the major risk of thyroid eye disease?

Answer 16

Compartment syndrome which can affect the optic nerve

Question 17

What are some extraocular signs of thyroid eye disease?

Answer 17

Proptosis, restrictive myopathy (poor movement), lid signs e.g. retraction, oedema, lag, pigmentation

Question 18

What is chemosis?

Answer 18

Swelling of the conjunctiva

Question 19

Thyroid eye disease can lead to what other eye condition?

Answer 19

Glaucoma

Question 20

What may be seen in the posterior segment of an individual with thyroid eye disease?

Answer 20

Choroidal folds, optic nerve swelling

Question 21

What are management options for thyroid eye disease?

Answer 21

Control of thyroid hormones, lubricants, surgical decompression

Question 22

Which connective tissue diseases can cause eye symptoms

Answer 22

SLE, RA, Sjogren’s, Marfan’s

Question 23

What can rheumatoid arthritis cause?

Answer 23

Keratoconjunctivitis sicca, scleritis, corneal melt

Question 24

What is the main eye condition that Sjogren’s will cause?

Answer 24

Keratoconjunctivitis sicca

Question 25

What eye condition is likely to occur in Marfan's syndrome?

Answer 25

Lens dislocation

Question 26

What is erythema multiforme?

Answer 26

A hypersensitivity reaction which occurs following an infection, usually with HSV

Question 27

What are some eye symptoms that Stevens Johnsons Syndrome and erythema multiforme can cause?

Answer 27

Conjunctivitis, occlusion of lacrimal glands, corneal ulcers

Question 28

What will a sixth nerve palsy result in?

Answer 28

Failure to abduct the affected eye

Question 29

What will a fourth nerve palsy result in?

Answer 29

Intorsion, depression in adduction, weak abduction

Question 30

What may patients with a 4th nerve palsy do to try and compensate?

Answer 30

Head tilt

Question 31

What can bilateral 4th nerve palsy cause?

Answer 31

Torsion and chin depression

Question 32

What usually causes bilateral 4th nerve palsy?

Answer 32

Head trauma

Question 33

What muscles does a 3rd nerve palsy affect?

Answer 33

MR, IR, SR, IO, sphincter pupillae, LPS

Question 34

What will the ocular position be in a 3rd nerve palsy?

Answer 34

Down and out

Question 35

If a 3rd nerve palsy is painful, what is the most likely cause?

Answer 35

Aneurysm

Question 36

What is the most likely cause of all nerve palsies?

Answer 36

Microvascular or tumours

Question 37

If not microvascular/tumour, what is the most likely cause of a 4th nerve palsy?

Answer 37

Trauma or congenital

Question 38

If not microvascular/tumour, what is the most likely cause of a 6th nerve palsy?

Answer 38

Raised ICP

Question 39

What are some causes of visual field defects?

Answer 39

Vascular disease, space occupying lesion, demyelination, trauma

Question 40

What condition is optic neuritis associated with?

Answer 40

MS

Question 41

What will optic neuritis cause?

Answer 41

Progressive unilateral visual loss with pain behind the eye, especially on eye movements

Question 42

Optic neuritis results in optic atrophy- what will this show on ophthalmoscopy?

Answer 42

Large cup to disc ratio

Question 43

Problems at the optic chiasm cause what visual field defect?

Answer 43

Bitemporal hemianopia

Question 44

Defects at the optic chiasm are usually caused by what?

Answer 44

Tumours (pituitary tumours, craniopharyngiomas, meningiomas)

Question 45

Are bitemporal hemianopias reversible?

Answer 45

Usually once the tumour is removed

Question 46

What kind of visual field defect will problems at the optic tract and radiations cause? What can this result in? Is this incongruous or congruous?

Answer 46

Homonomous defects where the macula is not spared - can cause quadrantinopia. This is incongruous.

Question 47

What kind of visual field defect will problems at the visual cortex cause? Is this incongruous or congruous?

Answer 47

Homonomous defects which are macula sparing. This is congruous.