Systemic Disease and Ocular Manifestations
What this domain tests
This section tests recognition of ocular signs of systemic disease and the optometrist’s role in co-management and medical referral. Diabetes, hypertension, thyroid disease, autoimmune disease and drug toxicity are high-yield areas.
Core rules and concepts
- Diabetic retinopathy is graded by microaneurysms, haemorrhages, exudates, venous changes and neovascularisation; sight-threatening grades need timely ophthalmology referral.
- Hypertensive retinopathy signs include arteriolar narrowing, flame haemorrhages and cotton-wool spots; severe signs may indicate systemic emergency.
- Thyroid eye disease causes lid retraction, proptosis, diplopia and optic-nerve compression.
- Hydroxychloroquine and long-term steroid use require ocular surveillance.
- Giant-cell arteritis can cause sudden visual loss and requires urgent medical assessment.
Worked example
A patient with diabetes has dot haemorrhages and hard exudates but no neovascularisation. Reasoning: this is non-proliferative diabetic retinopathy. The finding must be documented and communicated to the patient’s general practitioner and retinal screening pathway; refer for ophthalmological grading if there is macular oedema, unexplained acuity loss or a grade requiring specialist review.
Traps that cost marks
Missing neovascularisation at the disc or elsewhere; failing to refer a patient with sudden visual loss and scalp tenderness; not asking about systemic medicines; assuming good systemic control from a normal fundus.
Key points
- Grade diabetic retinopathy and refer sight-threatening disease.
- Sudden loss with scalp tenderness suggests giant-cell arteritis.
- Thyroid eye disease can compress the optic nerve.
- Hydroxychloroquine and steroids need ocular monitoring.
- Communicate findings to the GP and screening pathway.