Ocular Manifestations of Autoimmune Diseases
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Questions and Answers

What is the most common ocular manifestation in patients with Rheumatoid Arthritis (RA)?

  • Scleritis/episcleritis
  • Keratoconjunctivitis sicca (correct)
  • Peripheral corneal ulceration
  • Keratitis

    • Graves' Disease is an autoimmune condition resulting in hypothyroidism (underproduction of thyroid hormones).

    False

    What is the name of the ocular manifestation associated with Graves' Disease?

    Graves' ophthalmopathy

    The ocular manifestation keratoconjunctivitis sicca is more common in women and people over __________ years.

    <p>40</p> Signup and view all the answers

    Match the following diseases with their corresponding ocular manifestations:

    <p>Rheumatoid Arthritis (RA) = Graves' Disease Keratoconjunctivitis sicca = Graves' ophthalmopathy</p> Signup and view all the answers

    In patients with Systemic Lupus Erythematosus (SLE), what is the percentage of ocular disease occurrence?

    <p>20%</p> Signup and view all the answers

    Rheumatoid Arthritis (RA) is a chronic inflammatory disorder primarily affecting the joints.

    <p>False</p> Signup and view all the answers

    The treatment for keratoconjunctivitis sicca is _______________.

    <p>symptomatic</p> Signup and view all the answers

    What is the primary mechanism leading to tissue damage in limbal or peripheral corneal tissues in the context of ocular inflammation?

    <p>Deposition of immune complexes</p> Signup and view all the answers

    Sympathetic ophthalmia is a common disease that occurs after a penetrating injury to one eye.

    <p>False</p> Signup and view all the answers

    What is the typical time frame for the presentation of sympathetic ophthalmia after an ocular injury?

    <p>Between 2 weeks and 3 months</p> Signup and view all the answers

    The corneal examination in patients with keratoconjunctivitis sicca may reveal _______________________ keratopathy.

    <p>punctate erosive</p> Signup and view all the answers

    Match the following conditions with their associated ocular manifestations:

    <p>Sympathetic ophthalmia = Bilateral granulomatous uveitis Keratoconjunctivitis sicca = Dry eye syndrome</p> Signup and view all the answers

    What is the name of the theory that suggests uveal pigment antigens act as an allergen, leading to uveitis in the normal eye?

    <p>Allergic theory</p> Signup and view all the answers

    What is the name of the disease that is characterized by dry eye syndrome and is also known as keratoconjunctivitis sicca?

    <p>Sjögren's syndrome</p> Signup and view all the answers

    Sympathetic ophthalmia is more common in women than in men.

    <p>False</p> Signup and view all the answers

    Which type of hypersensitivity reaction is associated with autoimmune haemolytic anaemia?

    <p>Type II</p> Signup and view all the answers

    Mooren's ulcer is a systemic disease.

    <p>False</p> Signup and view all the answers

    What is the result of IgG antibodies binding to red cells in autoimmune haemolytic anaemia?

    <p>Opsonisation and phagocytosis by macrophages in the spleen</p> Signup and view all the answers

    In autoimmune haemolytic anaemia, IgM antibodies bind to red cells, leading to _______________ of the complement system.

    <p>activation</p> Signup and view all the answers

    Which autoimmune disease is associated with the destruction of insulin producing cells in the pancreas?

    <p>Type I diabetes mellitus</p> Signup and view all the answers

    Match the following autoimmune diseases with their corresponding ocular manifestations:

    <p>Rheumatoid arthritis = Inflammation and destruction of joints Systemic lupus erythematosus = Renal failure, skin lesions, etc. Graves' disease = Ophthalmopathy Mooren's ulcer = Painful, relentless, chronic ulcerative keratitis</p> Signup and view all the answers

    Immune complexes are usually cleared rapidly in the body.

    <p>True</p> Signup and view all the answers

    What is the result of immune-complex deposition in tissues in systemic lupus erythematosus?

    <p>Dysfunction (e.g. renal failure, skin lesions, etc.)</p> Signup and view all the answers

    What is the process by which the body eliminates self-reactive T- and B-cells?

    <p>Central tolerance</p> Signup and view all the answers

    Molecular mimicry is a process that prevents autoimmune diseases.

    <p>False</p> Signup and view all the answers

    What is autoimmunity?

    <p>A misdirected immune response that occurs when the immune system attacks the body itself.</p> Signup and view all the answers

    Tolerance is a mechanism for preventing ____________________.

    <p>autoimmunity</p> Signup and view all the answers

    What is the result of molecular mimicry?

    <p>An immune response against self-antigens</p> Signup and view all the answers

    Peripheral tolerance is induced in early stages of lymphocyte development.

    <p>False</p> Signup and view all the answers

    Match the following types of tolerance with their descriptions:

    <p>Central tolerance = Deleting self-reactive lymphocytes in early stages of development Peripheral tolerance = Suppressing autoreactive lymphocytes in mature lymphocytes</p> Signup and view all the answers

    What is the role of T-regulatory cells in peripheral tolerance?

    <p>Suppressing autoreactions</p> Signup and view all the answers

    What percentage of scleritis cases are caused by Rheumatoid Arthritis (RA)?

    <p>18-33%</p> Signup and view all the answers

    Scleritis and episcleritis have similar symptoms but distinct anatomical locations.

    <p>True</p> Signup and view all the answers

    What is the most common ocular complication of Diabetes Mellitus?

    <p>Diabetic Retinopathy</p> Signup and view all the answers

    Sjögren's syndrome is characterized by dry eyes and a dry ______________.

    <p>mouth</p> Signup and view all the answers

    Match the autoimmune diseases with their ocular complications:

    <p>Rheumatoid Arthritis = Scleritis Graves' Disease = Ophthalmopathy Systemic Lupus Erythematosus = Ocular manifestations Sjögren's Syndrome = Dry Eye</p> Signup and view all the answers

    Type 1 Diabetes Mellitus is a non-autoimmune condition.

    <p>False</p> Signup and view all the answers

    What is the primary goal of managing Diabetes Mellitus to prevent ocular complications?

    <p>All of the above</p> Signup and view all the answers

    What type of hypersensitivity reaction is associated with Type 1 Diabetes Mellitus?

    <p>Cell-mediated (type IV) hypersensitivity</p> Signup and view all the answers

    Study Notes

    Ocular Manifestations of Autoimmune Diseases

    • Keratoconjunctivitis sicca is a common ocular manifestation of autoimmune diseases, particularly in women over 40 years old.
    • Treatment of keratoconjunctivitis sicca is symptomatic.

    Rheumatoid Arthritis (RA)

    • RA is a chronic inflammatory disorder primarily affecting the joints, but also affecting the skin, eyes, lungs, heart, and blood vessels.
    • It is a cell-mediated (type IV) hypersensitivity reaction.
    • Approximately 25% of patients with RA will have ocular manifestations, including:
      • Keratoconjunctivitis sicca (most common, up to 25% of patients)
      • Scleritis/episcleritis (4-10% of patients with RA)
      • Keratitis
      • Peripheral corneal ulceration

    Graves' Disease

    • Graves' disease is an autoimmune condition resulting in hyperthyroidism (overproduction of thyroid hormones).
    • Inflammation and congestion of periocular and orbital soft tissue occur in Graves' disease.
    • Ocular manifestations of Graves' disease include:
      • Graves' ophthalmopathy
      • Exposure keratopathy
      • Diplopia
      • Compressive optic neuropathy

    Systemic Lupus Erythematosus (SLE)

    • SLE is an autoimmune disease that occurs more frequently in women, particularly those of childbearing age.
    • Ocular disease occurs in 20% of SLE patients, with external ocular manifestations including:
      • Keratoconjunctivitis sicca
      • Conjunctivitis
      • Uveitis
      • Episcleritis and scleritis
      • Keratitis
      • Discoid lupus rash over the eyelids
    • Intraocular manifestations of SLE include:
      • Microinfarction
      • Hemorrhage
      • Vasculitis in various locations
      • Optic neuritis/optic neuropathy

    Sympathetic Ophthalmia

    • Sympathetic ophthalmia is a rare, bilateral, granulomatous uveitis that occurs after a penetrating injury to one eye.
    • It is a potentially blinding disease that involves both eyes.
    • More frequent in men, with a possible association with HLA-A11.
    • Predisposing factors include:
      • Penetrating injury (almost always occurs after a penetrating injury)
      • Ciliary region wounds = dangerous zone
    • Pathogenesis involves multiple theories, including the "allergic theory" and molecular mimicry.

    Keratoconjunctivitis Sicca

    • Keratoconjunctivitis sicca is a dry eye syndrome.
    • Symptoms include:
      • More prominent during the latter part of the day due to the evaporation of the tear film
      • Corneal examination (slit lamp) may reveal punctate erosive keratopathy or filaments

    Scleritis and Episcleritis

    • Scleritis and episcleritis are distinguished based on anatomy and appearance.
    • Symptoms may be similar, with scleritis having more severe pain and tenderness to palpation of the globe.
    • Scleritis is more common in patients with RA, and patients with scleritis and RA have a worse prognosis.

    Diabetes Mellitus (Type 1)

    • Diabetes mellitus is an autoimmune condition where the insulin-producing cells in the pancreas are destroyed.
    • It leads to elevated blood glucose levels and damages the blood vessels in most organ systems, including the eye.
    • Ocular complications include:
      • Diabetic retinopathy
      • Cataract formation
      • Glaucoma
    • Prevention of complications involves controlling blood sugar levels and regular eye exams.

    Sjögren's Syndrome

    • Sjögren's syndrome is an autoimmune condition characterized by dry eyes and a dry mouth.
    • It results in decreased production of tears and saliva due to molecular mimicry.

    Classification of Autoimmune Conditions

    • Autoimmune conditions are classified similarly to hypersensitivity reactions, with the exception of type I hypersensitivity.
    • Types of autoimmune conditions include:
      • Antibody-mediated (type II) hypersensitivity reactions
      • Immune-complex mediated (type III) hypersensitivity reactions
      • Cell-mediated (type IV) hypersensitivity reactions

    Mooren's Ulcer

    • Mooren's ulcer is a rare disorder characterized by a painful, relentless, chronic ulcerative keratitis.
    • It typically occurs in healthy, adult men, with no evidence of systemic disease.
    • Etiology is unsure, but possible autoimmune reactions include exposure to infectious agents.

    Autoimmunity

    • Tolerance is the mechanism for preventing autoimmunity, where self-reactive T- and B-cells are removed.
    • Autoimmunity occurs when the immune system goes awry and attacks the body itself, triggering hypersensitivity reactions to self-antigens.
    • Molecular mimicry is a process where foreign antigens initiate an immune response, leading to cross-reactive immune responses against self-antigens.

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    Autoimmunity Session 7 PDF

    Description

    Learn about the ocular manifestations of autoimmune diseases, including keratoconjunctivitis sicca and its relation to rheumatoid arthritis. Understand the symptoms and treatment options.

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