ocular manifestations of systemic diseases dr.turki al- turki consultant ophthalmlogist
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THE EYE & THE BODY. Ocular Manifestations of Systemic Diseases Dr.Turki AL- Turki Consultant Ophthalmlogist. NORMAL FUNDUS. Cardiovascular diseases. Flame shaped hemorrhages. Cotton wool spots. Hard exudates. Flame shaped hemorrhages. Central retinal vein occlusion. - PowerPoint PPT PresentationTRANSCRIPT
Ocular Manifestat
ions of
Systemic Diseases
Dr.Turki AL-TurkiConsultant Ophthalmlogist
THE EYE & THE BODY
NORMAL FUNDUS
Cardiovascular diseases
Flame shaped hemorrhages
Flame shaped hemorrhages
Cotton wool spots
Hard exudates
Grade IV Hypertensive Retinopathy Central retinal vein occlusion
Branch retinal vein occlusion
Second most common cause of vascular-related visual loss.
Risk factorsHypertension CoagulopathyVasculitis (Behcets,sarcoidosis,AIDS,SLE)
Diagnostic workup BP measurement Lipid profile ECG Echocardiography Carotid Doppler
Consider risk factors Hypertension Carotid artery diseases Cardiac Arrhythmias Coagulopathy
Cardiovascular diseases
Central retinal artery occlusion
OCULAR EMERGENCY
Diabetes MellitusA cause of 4000 new case of blindness/year.Risk factors
• Family history• Duration of disease• Type of DM• Use of insulin• Poor metabolic control• Presence of Co-morbid conditions
HypertensionHyperlipidemiaRenal diseaseSmokingAlcohol consumptionAnemiaObesityPregnancy
Mild non-prolifrative diabetic retinopathy Moderate non-prolifrative diabetic retinopathy
Sever non-prolifrative diabetic retinopathy
Proliferative diabetic retinopathy
Tractional retinal detachment
• Argon laser pan-retinal photocoagulation (PRP).
• Focal laser treatment for macular edema.• Intravitreal injection of steroids• Intravitreal injections of anti-vascular
endothelial growth factor (Anti-VEGF)
• Third (Oculomotor) cranial nerve palsy.
Diabetes Mellitus
Complete 3rd nerve palsy
MAKE SURE THAT THE PUPIL IS NORMALLY REACTING IN 3RD NERVE PALSY
Thyroid eye disease
Unilateral lid retractionUnilateral proptosis
Bilateral lid retractionBilateral proptosis
In 50% of cases
1. Soft tissue involvement• Periorbital and lid swelling• Conjunctival hyperemia• Chemosis• Superior limbic keratoconjunctivitis
2. Eyelid retraction3. Proptosis4. Optic neuropathy5. Restrictive myopathy
Thyroid eye disease
Lid lag on down gaze movement
Proptosis
Treatment options • Systemic steroids • Radiotherapy • Surgical decompression
• Occurs in about 50% • not influenced by treatment of hyperthyroidism
Axial and permanent in about 70% May be associated with choroidal folds
Soft tissue involvementPeriorbital and lid swelling
Chemosis
Conjunctival hyperaemia
Superior limbic keratoconjunctivitis
Optic neuropathy• Occurs in about 5% • Early defective colour vision • Usually normal disc appearance
Caused by optic nerve compression at orbital apex by enlarged recti muscles Often occurs in absence of significant
proptosis
• Occurs in about 40% • Due to fibrotic contracture
Restrictive myopathy
Elevation defect - most common Abduction defect - less common
Depression defect -uncommon Adduction defect - rare
Inflammatory conditions(Sarcoidosis)
• Idiopathic multisystem disorder• Characterised by non-caseating
granuloma• More common in women 20-50 yrs• More common in blacks and Asians• Eyes – 30%
Inflammatory conditions(Sarcoidosis)
Anterior segment lesions (30%)• Conjunctival granuloma• Acute or chronic uveitis• Lacrimal gland involvement& dry eye
Posterior segment lesions (20%)• Patchy venous sheathing• Cellular infiltrate around vessels• Chorioretinal granulonmas• Vasculitis• Neovascularisation• Infiltrate in vitreous (vitritis)
Sickle cell retinopathy
New vessel formation Sea fan neovascularizationHyphema
Leukemia
White centered hemorrhage (Roth’s spot)Sterile hypopyon
Metastatic renal cell carcinoma Metastatic lymphoma
Metastatic lung cancer
Metastasis
Neurofibromatosis type-1 (NF-1)
Most common phacomatosisAffects 1:4000 individualsPresents in childhood
Café-au-lait spots
Appear during first year of lifeIncrease in size and number throughout
childhood
Eyelid neurofibromas in NF-1
Nodular Plexiform
May cause mechanical ptosis May be associated with glaucoma
Intraocular lesions in NF-1Lisch nodules
Very common - eventually present in 95% of cases
Congenital ectropion uveae
Uncommon - may be associated with glaucoma
Retinal astrocytomas
Rare - identical to those seen intuberous sclerosis
Choroidal naevi
Common - may be multifocal and bilateral
Ocular features of NF-2
Common - combined hamartomas of RPE and retina
Very common -presenile cataract
Peripheral corneal involvement in Rheumatoid arthritis,Wegener granulomatosis, polyarteritis nodosa
• Chronic and asymptomatic• Circumferential thinning with intact
epithelium (‘contact lens cornea’)
• Acute and painful• Circumferential ulceration and
infiltration
Treatment - systemic steroids and/or cytotoxic drugs
Without inflammation With inflammation
GIANT CELL ARTERITIS
• Headache• Scalp tenderness• Thickened temporal arteries• Jaw claudication• Acute visual loss• Weight loss, anorexia, fever, night
sweats, malaise & depression
Ocular Complications• Transient monocular visual loss
(amaurosis fugax)• Visual loss due to
– Central retinal artery occlusion (CRAO) or
– Anterior ischaemic optic neuropathy (AION)
• Visual field defects
Systemic signs & symptoms
Systemic infections
• Tuberculosis• Syphilis• HIV• Toxoplasmosis• Brucellosis• Herpes zoster• Candida infection
• Can affect any part of the eye
• Lids optic nerve.• Can be limited to the eye
only Difficult Dx
• Requires systemic antimicrobial therapy PLUS Steroids
• Can cause severe visual loss secondary to inflammation and infection.
Systemic infections
Retinitis with vasculitisEndogenous endophthalmitis
Systemic infections
Herpes Zoster OphthalmicusAnterior Uveitis