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SPM- Opthamology > Systemic Disease and the Eye > Flashcards

Systemic Disease and the Eye Flashcards

1
Q

What thyroid disease is associated with unique eye changes?

A

Grave’s Disease

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2
Q

What are the features of Grave’s Disease?

A

Proptosis
Lid Lag
Lid retraction
Exopthalmus

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3
Q

Why does Grave’s Disease cause eye changes?

A

Anti-bodies (also stimulate TSH receptors) cause inflammation of the extra-occular muscles and peri-robital tissues. This is an enclosed space and so causes the eye to protrude.

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4
Q

What may be seen on imaging of a patient with Grave’s eye disease?

A

Swollen extra-ocular muscles

Proptosis of the eye

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5
Q

Why is Grave’s eye disease concerning for ocular reasons?

A

Inflammation can cause blindness due to compression of the optic nerve. The orbit doesn’t permit expansion.

Corneal perforation- eye lids and tear film normally protect the cornea and sclera but when they are protruded this is not as possible which can lead to thinning and perforation of the cornea.

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6
Q

Why does Grave’s Disease cause corneal perforation?

A

Proptosis prevents proper closure of the eye lids. This normally protects the cornea and prevents drying out. Patients who cannot properly close their eyes are prone to their cornea drying out and perforating.

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7
Q

What worrying thing can cause a third nerve palsy?

A

PCA aneurysm-

May also have headache. Request a Cerebral Angiogram

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8
Q

What eye symptoms can myasthenia gravis cause?

A

Drooping eye lid
Double vision
Decreased ROM

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9
Q

What are the features of Horner’s Syndrome?

A

Meiosis (constricted pupil)
Ptosis
Anhydrosis
(Different size of pupils evident in low light)

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10
Q

What causes Horner’s syndrome?

A

Compression of the sympathetic chain anywhere along it’s root.

Apical lung carcinoma
Carotid Aneurysm/ dissection

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11
Q

How might cardiovascular disease cause ocular issues?

A 
Hypertensive retinopathy
Central artery occlusion
Central vein occlusion
(Or branches of above)
Amaurosis Fugax
Anterior ischaemic optic neuropathy
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12
Q

What association is there in ophthalmology with sero-negative arthropathies?

A

Sero-negative arthropathies are associated with anterior uveitis (inflammation of iris). These are the ones that are HLA-B27 positive a lot of the time.

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13
Q

What rheumatology condition is a cause of dry eyes?

A

Sjogren’s disease

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14
Q

What condition must be ruled out with anterior ischaemic optic neuropathy?

A

Giant Cell Arteritis

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15
Q

What is episcleritis? Is it painful?

A

Bleeding and inflammation in the outer sclera. Unlike conjunctivitis this is segmentally red. It is not painful.

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16
Q

What is scleritis? Is it painful?

A

Scleritis is very painful
It is the inflammation of the sclera
It is dilation of deeper blood vessels than episcleritis (non-painful)

Can also be posterior so not visible initially.

17
Q

What is a condition is scleritis and episcleritis associated with?

A

Rheumatoid arthritis

18
Q

What is a corneal melt?

A

Cornea thins due to inflammation

Can progress to corneal perforation and requires high dose systemic immunosuppression (e.g. steroids)

19
Q

What is a posterior synechiae? What condition may it occur with?

A

Iris adheres to the anterior surface of the lens due to inflammatory exudate in anterior uveitis

When the iris attempts to dilate it cannot due to adhesions

20
Q

What features are seen with Behcets Disease?

A

Oral ulcers with 2 of:
Recurrent genital ulceration
Skin lesions- folliculitis, erythema nodosum
Positive pathergy test- pustular reaction after pricking the skin with a needle
Eye involvement- Acute anterior uveitis, vitritis, vasculitis, retinitis (Eye disease is seen in 75%)

21
Q

What is the treatment for Behcet’s Disease?

A

Immunosuppression

22
Q

What may be seen in acute anterior uveitis?

A

Redness
Hypopyon- inflammatory material in anterior chamber
Reduced clarity of cornea
Corneal infiltration

23
Q

What condition is temporal arteritis associated with?

A

PMR

24
Q

What is blepharitis? What symptoms does it cause?

A

Disorder of the meibomian glands that causes inflammation of the lid margin when the glands become obstructed. This can cause a sensation of gritty eye and dry eye.

25
Q

Describe some of the features of Steven Johnsons Syndrome?

A

Mucosal linings and skin affected

Fever, Malaise, Sore Throat, Arthralgia

Eye- Pseudomembranous conjunctivitis, cicatrisation of conjuctiva (scarring process) and lids
Skin- Erythematous maculopapules, vesicubullous lesions, skin denudation
Motuh- Bullae, erosions, haemorrhagic crusts

26
Q

What is Stevens Johnson Syndrome?

A

Acute immune mediated reaction to drugs or infection

Toxic Epidermal Necrolysis is more severe form.

27
Q

What process leads to Stevens Johnson Syndrome?

A

Type IV Hypersensitivity- Cytotoxic T Cells cause damage and inflammation. Loss of epithelium cells causes epithelium to shed from lamina propria.

This occurs due to drugs or infection which cause the cells to be perceived as foreign by CD8 T cells.

28
Q

What can HSV cause at the eye?

A

Viral keratitis

29
Q

What is Hutchinson Sign?

A

Involvement of the side of the nose on the affected side (vesicles there) suggests naso-cilliary branch involvement and there is a greater risk of ophthalmic involvement.

30
Q

What is mucous membrane pemphigoid?

A

Immune mediated disease that cause inflammation followed by scarring. Affects the skin in 25%.

Inflammation at the eye can lead to scarring.
Oral lesions are seen in 80%- submucosal blisters leading to erosions, scars and strictures.

31
Q

What unique feature is seen in Sturge-Weber Syndrome?

A

Port wine stain

32
Q

What features are seen in Sturge-Weber Syndrome?

A

Mental retardation
50% have glaucoma
Port wine stain

33
Q

What features suggest basal cell carcinoma?

A

Pearly rolled edge
Telangiectasia
Central ulceration

34
Q

Which STIs are associated with conjunctivitis?

A

Gonorrhoea (causes eye disease in the new born)
Chlamydia
HIV- associated with opportunistic infection of the eye

35
Q

What is CMV retinitis associated with?

A

HIV- haemorrhage and infiltrate in supero temporal cascade

36
Q

What eye complication are steroids associated with causing?

A

Accelerated cataract development- posterior sub-capsular cataract
Secondary glaucoma

SPM- Opthamology (11 decks)

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