The Eye in Systemic Disease

Question 1

name the 5 signs of non proliferative retinopathy

Answer 1

1. micro aneurysms - dot and blot haemorrhages
2. hard exudate
3. cotton wool patches
4. abnormal venous calibre
5. IRMA - intra-retinal microvascular abnormalities

Question 2

loss of _________ results in microaneurysms

Answer 2

loss of PERICYTES results in microaneurysms

Question 3

which 3 places can new vessels grow?

Answer 3

1. disc (NVD)
2. periphery (NVE)
3. iris if ischaemia is severe

Question 4

what is rubeosis iridis?

Answer 4

growth of new vessels onto the iris

Question 5

name the 3 things that diabetic patients can lose vision from

Answer 5

1. retinal oedema
2. vitreous haemorrhage
3. scarring and retinal detachment

Question 6

name the 3 classifications of retinopathy

Answer 6

1. no retinopathy
2. non-proliferative retinopathy - mild, moderate and severe
3. proliferative retinopathy

Question 7

name the 4 classifications of maculopathy

Answer 7

1. no maculopathy
2. observable maculopathy
3. referable maculopathy
4. clinically significant maculopathy

Question 8

name the management for diabetic retinopathy (4)

Answer 8

medical management
laser - PRP or macular grid
surgery
rehabilitation

Question 9

cotton wool patches are seen in diabetic patients but also in patients with what condition?

Answer 9

hypertension

Question 10

name the 5 features of hypertensive retinopathy

Answer 10

1. attenuated blood vessels-copper or silver wiring
2. cotton wool spots
3. hard exudates
4. retinal haemorrhage
5. optic disc oedema

Question 11

sudden painless loss of vision

cattle trucking of artery

very profound loss of vision

retinal nerve fibre layer becomes swollen except at fovea (cherry red spot)

rarely recovers

diagnosis?

Answer 11

central retinal artery occlusion

Question 12

sudden painless visual loss

range of visual loss

need to determine degree of ischaemia

Ischaemia correlates to degree of reduced vision and fundal appearances

diagnosis?

Answer 12

CRVO

Question 13

what does a robotic eye look like?

Answer 13

vessels surrounding pupil encroaching on the iris

google it

Question 14

1. common in Africa
2. huge exudation on fundus
3. bilateral hiliar lymphadenopathy on CXR

diagnosis?

Answer 14

sarcoidosis

Question 15

name some infective and non-infective causes of uveitis

Answer 15

infective - TB, herpes zoster, toxoplasmosis…

non-infective - idiopathic, HLA-B27, juvenile arthritis, sarcoidosis

Question 16

1. enlarged temporal artery
2. old pathient
3. swollen optic nerve head

diagnosis?

Answer 16

giant cell arteritis

Question 17

what condition is giant cell arteritis associated with?

Answer 17

polymyalgia rheumatica

Question 18

name the symptoms of giant cell arteritis

Answer 18

headache
jaw claudication
malaise
raised PV
blinding condition

Question 19

name the main feature of thyroid eye disease

Answer 19

proptosis

Question 20

name the important antibody in SLE that causes ocular inflammation

Answer 20

anti-DNA Ab

Question 21

dry eyes (keratoconjunctivitis sicca), scleritis and corneal melt is seen in which inflammatory condition?

Answer 21

rheumatoid arthritis

Question 22

the following triad:

keratoconjunctivitis sicca
xerostomia
rheumatoid arthritis

is seen in which syndrome?

Answer 22

sjogren’s syndrome

lacrimal glands are also infiltrated

Question 23

lens displacement without trauma, long fingers and a high arched palate is seen in what condition?

Answer 23

marfans

Question 24

which way is the lens displaced in marfans syndrome?

Answer 24

UP!

Question 25

symblepharon occlusion of lacrimal glands corneal ulcers dermatological diagnosis?

Answer 25

stevens-johnson syndrome

Question 26

what is the gold standard imaging technique to identify cause of eye disease?

Answer 26

MRI scanning

Question 27

name the following nerves: (a) CN III (b) CN IV (c) CN VI

Answer 27

(a) CN III - oculomotor (b) CN IV - trochlear (c) CN VI - abducens

Question 28

what eye muscle does CN VI supply?

Answer 28

lateral rectus muscle

Question 29

what does the lateral rectus muscle do?

Answer 29

adduction of the eye

Question 30

name the main cause and other causes of VIth nerve palsy

Answer 30

main: raised ICP other: microvascular, tumour and congenital

Question 31

what muscle does the IVth nerve supply?

Answer 31

superior oblique

Question 32

what actions does the superior oblique muscle perform

Answer 32

intorsion depression in adduction abduction (weak)

Question 33

what is seen in a patient with a IVth nerve palsy?

Answer 33

head tilt right tilt if left IV palsy left tilt if right IV palsy

Question 34

what is the main cause of IVth nerve palsy?

Answer 34

congenital decompensated (inability to fuse images together) and trauma

Question 35

what muscles do CN III innervate?

Answer 35

all the rest ``` medial rectus muscle inferior rectus superior rectus inferior oblique sphincter pupillae levator palpebrae superioris ```

Question 36

what is the ocular position in a IIIrd nerve palsy?

Answer 36

down and out

Question 37

name the main and other causes of a IIIrd nerve palsy

Answer 37

main: aneurysm (circle of willis) other: microvascular, tumour, MS and congenital

Question 38

what should you suspect in a painful IIIrd nerve palsy?

Answer 38

ANEURYSM!!!

Question 39

inter-nuclear ophthalmoplegia is seen in patients that have had what?

Answer 39

a stroke

Question 40

inter-nuclear ophthalmoplegia causes?

Answer 40

multiple sclerosis - demyelination is main and vascular is other

Question 41

name the most common pathology of the optic nerve

Answer 41

ischaemic optic neuropathy

Question 42

name the pathology of the optic nerve that is seen commonly in MS

Answer 42

optic neuritis

Question 43

optic nerve defects are ________ or abide the __________

Answer 43

optic nerve defects are COMPLETE or abide the HORIZONTAL

Question 44

progressive visual loss (unilateral) pain behind eye, especially on movement colour desaturation central scotoma gradual recovery over weeks - months diagnosis?

Answer 44

optic neuritis

Question 45

name the most common pathology at the optic chiasm

Answer 45

pituitary tumour also craniopharyngioma and meningioma

Question 46

what visual field is seen in pathology of the optic chiasm

Answer 46

bi-temporal field defect

Question 47

is visual loss reversed after a pituitary tumour is removed?

Answer 47

yes

Question 48

what pathology is seen in the optic tracts and radiation?

Answer 48

tumours demyelination vascular anomalies

Question 49

what visual field defect is seen in pathology of the optic tract?

Answer 49

homonomous defects macula not spared quadrantanopia incongruous (non-symmetrical)

Question 50

what pathology is seen at the occipital cortex and what is the visual field defects enthuse patients?

Answer 50

pathology: vascular disease and demyelination visually: homonomous defect, macular sparing and congruous (symmetrical)