Ocular Manifestations of Systemic Disorders Practice Questions

Q: Patient with acute pancreatitis developed sudden loss of vision; the most likely cause is:

Purtscher's retinopathy. ***Purtscher's retinopathy*** - **Purtscher's retinopathy** is a rare but classic complication of acute pancreatitis, presenting with **sudden vision loss** due to retinal ischemia. - It is characterized by **Purtscher flecken**, which are multifocal areas of retinal whitening with clear zones separating them from the retinal vessels, and often bilateral. *Hyperglycemia* - While complications of diabetes can affect vision, severe hyperglycemia itself typically causes **gradual vision changes** due to osmotic shifts in the lens, not sudden loss. - Acute vision loss due to hyperglycemia would more likely relate to **diabetic retinopathy exacerbation** or **vitreous hemorrhage**, which are not directly implied by acute pancreatitis alone. *Hypoxia* - **Severe systemic hypoxia** can lead to retinal ischemia and vision changes, but sudden, dramatic vision loss specifically from hypoxia is less common than from Purtscher's in the context of acute pancreatitis. - Although pancreatitis can lead to respiratory distress and hypoxia, Purtscher's retinopathy is a more specific and direct ocular complication. *Central Retinal Vein Occlusion (CRVO)* - **CRVO** causes sudden, painless vision loss usually in **one eye** due to a blockage in the central retinal vein. - While pancreatitis increases the risk of hypercoagulability, CRVO is not the most common or specific cause of sudden vision loss associated with acute pancreatitis.

Q: The most common ophthalmic affection of diphtheria is –

Isolated ocular palsies. ***Isolated ocular palsies*** - Diphtheria exotoxin can lead to localized neuropathies, and **ocular muscle palsies** are common, often affecting individual extraocular muscles rather than generalized paralysis. - Involvement typically presents as problems with **accommodation** or specific ocular movements due to cranial nerve involvement. *Ptosis* - While ptosis can occur due to **oculomotor nerve dysfunction**, it is less common as an isolated, primary ophthalmic manifestation of diphtheria compared to other ocular palsies. - It usually indicates more widespread **Cranial Nerve III involvement**, which is not the most frequent initial or isolated ocular finding. *Total ophthalmoplegia* - This involves paralysis of **all extraocular muscles**, which is a severe and less common manifestation of diphtheria. - Diphtheria typically causes more **localized and incomplete palsies** rather than affecting all eye movements universally. *Ophthalmoplegia externa* - This involves paralysis of the **extraocular muscles** but spares the **intrinsic eye muscles** (pupil and accommodation). - While diphtheria *can* cause external ophthalmoplegia, **isolated ocular palsies** (which include external ophthalmoplegia) more accurately describe the common presentation of affecting specific muscles or nerves.

Q: Which of the following can be associated with sarcoidosis?

Granulomatous anterior uveitis. ***Granulomatous anterior uveitis*** - **Granulomatous anterior uveitis** is the **most common and characteristic** ocular manifestation of **sarcoidosis**, characterized by inflammatory cells clumping together in the anterior chamber. - Classic findings include **mutton-fat keratic precipitates**, iris nodules (Koeppe and Busacca nodules), and posterior synechiae. - It can lead to complications such as glaucoma, cataracts, and posterior segment involvement. *Band keratopathy* - **Band keratopathy** is a corneal degeneration characterized by calcium deposits in the superficial cornea, typically seen in chronic ocular inflammation, hypercalcemia, or certain systemic disorders. - While sarcoidosis can cause **hypercalcemia** (in 10-20% of cases) which may lead to band keratopathy, this is an **indirect and uncommon** association. - **Granulomatous anterior uveitis** is the **direct, hallmark** ocular manifestation of sarcoidosis, making it the better answer. *Angioid streaks* - **Angioid streaks** are breaks in Bruch's membrane, associated with systemic conditions such as **pseudoxanthoma elasticum**, Ehlers-Danlos syndrome, Paget's disease, and sickle cell disease, but **not sarcoidosis**. - They can lead to choroidal neovascularization and vision loss. *Diabetic retinopathy* - **Diabetic retinopathy** is a microvascular complication of **diabetes mellitus**, characterized by damage to the retinal blood vessels. - It is **completely unrelated to sarcoidosis**.

Q: Dalen-Fuchs nodules are seen in which of the following?

Sympathetic ophthalmitis. ***Sympathetic ophthalmitis*** - **Dalen-Fuchs nodules** are characterized by accumulations of **lymphocytes, epithelioid cells, and pigment** in the choroid, specifically between Bruch's membrane and the retinal pigment epithelium. - They are a **pathognomonic sign** of sympathetic ophthalmitis, an autoimmune inflammatory reaction in the contralateral eye after penetrating trauma or surgery to the other eye. - These nodules represent a **granulomatous inflammatory response** and are a key histopathological finding. *Retinal detachment* - This condition involves the **separation of the neurosensory retina** from the underlying retinal pigment epithelium. - It is typically characterized by symptoms such as **flashes of light, floaters**, and a **darkening peripheral visual field**, rather than specific nodular formations in the choroid. *Spring catarrh* - Also known as **vernal keratoconjunctivitis**, this is a severe, chronic, bilateral inflammation of the conjunctiva, primarily affecting children and young adults, often with a history of atopy. - Its characteristic features include **papillae on the upper tarsal conjunctiva** and **Trantas dots** (collections of eosinophils and epithelial cells) at the limbus, not Dalen-Fuchs nodules. *Vogt-Koyanagi-Harada disease* - While VKH disease can also show Dalen-Fuchs nodules as it shares similar granulomatous uveitis features, it is a **distinct bilateral panuveitis** with systemic manifestations including **poliosis, vitiligo, dysacusia, and meningismus**. - The key differentiating factor is that **sympathetic ophthalmitis requires prior trauma or surgery to one eye**, whereas VKH disease has no such requirement and presents with characteristic extraocular manifestations.

Q: In Sturge-Weber syndrome, the MOST characteristic ocular manifestations include:

Hemangioma of choroid and glaucoma. ***Hemangioma of choroid and glaucoma*** - **Sturge-Weber syndrome** is a neurocutaneous disorder characterized by a **port-wine stain** on the face, usually involving the V1 distribution of the trigeminal nerve. - The most characteristic ocular manifestations include **choroidal hemangioma** and **glaucoma**, which occur together in this syndrome. - **Glaucoma** develops due to increased episcleral venous pressure or angle abnormalities and is a major cause of vision loss in affected individuals. - This option is the **most complete answer** as it includes both key ocular features. *Choroidal hemangioma* - While **choroidal hemangioma** is indeed present in Sturge-Weber syndrome, this option is **incomplete** as it does not mention the equally important association with **glaucoma**. - **Glaucoma** is a critical complication that requires monitoring and management in these patients. - Choosing this option would miss the full clinical picture. *Pulsating exophthalmos* - **Pulsating exophthalmos** is typically associated with a **carotid-cavernous fistula**, where arterial blood shunts into the cavernous sinus, causing pulsatile protrusion of the eyeball. - This is not a classic ocular feature of **Sturge-Weber syndrome**. *Lisch nodules* - **Lisch nodules** (iris hamartomas) are pathognomonic for **Neurofibromatosis type 1 (NF1)**, a different neurocutaneous disorder. - They are not associated with **Sturge-Weber syndrome**.

Q: Which of the following conditions is associated with granulomatous uveitis?

Vogt-Koyanagi-Harada's disease. ***Vogt-Koyanagi-Harada's disease*** - This systemic autoimmune condition characteristically presents with **bilateral, chronic granulomatous panuveitis**. - Other typical findings include **neurologic symptoms** (meningism, tinnitus) and **dermatologic manifestations** (vitiligo, poliosis, alopecia). *Fuchs' heterochromic iridocyclitis* - This condition is typically associated with **non-granulomatous anterior uveitis**. - Key features include **heterochromia** (different colored irises), diffuse stellate keratic precipitates, and often a cataract. *Behcet's disease* - Behcet's disease causes a **non-granulomatous panuveitis**, which is often recurrent and severe. - It is characterized by **recurrent oral and genital ulcers**, erythema nodosum, and pathergy. *Psoriatic arthritis* - Uveitis associated with psoriatic arthritis is usually **acute, unilateral, and non-granulomatous anterior uveitis**. - It is often seen in conjunction with **psoriatic skin lesions** and arthritis, commonly affecting the peripheral joints.

Question 1

Patient with acute pancreatitis developed sudden loss of vision; the most likely cause is:

Accepted Answer

Purtscher's retinopathy

Answer

Hypoxia

Answer

Central Retinal Vein Occlusion (CRVO)

Answer

Hyperglycemia

Question 2

The most common ophthalmic affection of diphtheria is –

Accepted Answer

Isolated ocular palsies

Answer

Ptosis

Answer

Total ophthalmoplegia

Answer

Ophthalmoplegia externa

Question 3

Which of the following can be associated with sarcoidosis?

Accepted Answer

Granulomatous anterior uveitis

Answer

Band keratopathy

Answer

Diabetic retinopathy

Answer

Angioid streaks

Question 4

Dalen-Fuchs nodules are seen in which of the following?

Accepted Answer

Sympathetic ophthalmitis

Answer

Retinal detachment

Answer

Spring catarrh

Answer

Vogt-Koyanagi-Harada disease

Question 5

In Sturge-Weber syndrome, the MOST characteristic ocular manifestations include:

Accepted Answer

Hemangioma of choroid and glaucoma

Answer

Lisch nodules

Answer

Pulsating exophthalmos

Answer

Choroidal hemangioma

Question 6

Which of the following conditions is associated with granulomatous uveitis?

Accepted Answer

Vogt-Koyanagi-Harada's disease

Answer

Fuchs' heterochromic iridocyclitis

Answer

Behcet's disease

Answer

Psoriatic arthritis

Ocular Manifestations of Systemic Disorders — MCQs

Ocular Manifestations of Systemic Disorders — MCQs

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