Non proliferative diabetic retinopathy- features
Haemorrhages
Microaneurysms
Cotton wool spots
Venous beading
Proliferative diabetic retinopathy -features
New vessels ( coming towards you not flat on disc) Subhyaloid haemorrhages
What is the rationale behind laser use in prolif DR?
Ischaemic areas are releasing the vasoproliferative factors
If laser, reduces stimulus for new vessel formation
Fenofibrate in diabetic retinopathy- what is the application and how good is it?
TYPE II DM
50% reduction over 5 years in diabetic complications
34% reduction in eye complications
One tab per day
Regulates the expression of many different genes, with a range of beneficial effects on lipid control, inflammation, angiogenesis, and cell apoptosis
Also used in hypercholesterolaemia and mixed dyslipidaemia.
What does VEGF inhibitor do in diabetic retinopathy?
Eg monthly intravitreal injections of ie Bevacizumab reduces swelling at the back of the eye at the macula
What is special about the diabetic 6th nerve palsly?
spares the pupil
What is the most common CN palsy in diabetes?
6th palsy
What does optic neuropathy look like vs optic atrophy
First may progress to second
First looks like blurred optic disc, swollen with haemorrhages
Second looks like well defined bright white disc
How does NO SPECS describe thyroid eye disease progression?
No signs of sx Signs but no sx soft tissue involvement Proptosis Extrocular muscle involvement (typically thick medial rectus) Corneal involvement from exposure Sight loss
on CT tendons spared, in infiltrative like lymphoma tendons also enlarged
MEN 2B has what eye sign
neuromas on conjunctiva
plus pheochromocytoma
medullary thyroid ca
GI ganglioneuromas
Hypertensive retinopathy- findings
AV nicking
opacity of arteriolar walls with copper wiring
Haemorrhage dot blot flame
Microaneurysm
Cotton wool spot
Hard exudate
If malignant hypertension see swelling of the optic disc
Cherry red spot means
Central retinal artery occlusion
Dilater veins and lots of haemorrhages at back of the eye
Central retinal vein occlusion
SBE retinal finding-
Roth spots- white centred round haemorrhage
Represent INFECTED EMBOLI
Can get similar looking thing in leukaemia from fibrin platelet clot
MS eye findings
Optic neuritis Progresses to optic atrophy INO Nystagmus Can get a macular star but not so common
Eye problems in RA
Keratoconjunctivitis sicca
Scleritis- doesnt blanche like episcleritis
Corneal melt
Brown syndrome (superior oblique tendon sheath syndrome)
Chloroquine toxicity- bulls eye macula
Chloroquine deposits in corne causing mares tail
Anterior uveitis
Retinal vasculitis
Which part of visual field lost in temporal arteritis
Painless visual loss
Its an ischaemic optic neuropathy affecting the superior ciliary artery
superior often predominantly
Anterior uveitis in -
Becets
IBD
psoriasis
ank spond
lens dislocation which direction in Marfans
Up and in
Kayser fleischer rings in ….
Wilsons
PBC
Chronic active hepatitis
Myasthenia eye findings
Fatiguable ptosis
Better with ice cube
Pupils can be unequal and poorly reactive
Variable double vision
Blue sclera in …
Osteogenesis imperfecta
Immunosuppressed eye diseases think…
CMV retinitis
Kaposi sarcoma of conjunctiva
Toxoplasma
TB
IVDU eye problem when mix with lemon?
Candida fluff balls in vitreous and macula
Sarcoid eye causes
Chronic granulomatous uveitis
Perivenous sheathing
Deposits in orbits bulging under eyes
Where do you get mets in eyes and what primaries?
Posterior segment
Women breast
Men lung
Also goes to orbit- Note that they cause exopthalmos except schirous ca of breast which is fibrous and causes enophthalmos
Leukaemia in eye causes?
Hypopion
Leukaemic cells with fluid level in anterior chamber
Also papilloedema and roth spots
Neurofibromatomis in eye
Pulsatile enophthalmos
Lisch nodules- brown spots on iris