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Ocular manifestations of systemic diseases

ocular manifestation of systemic disease

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Ocular manifestations of systemic diseases

  1. 1. Ocular Manifestations Of Systemic Diseases
  2. 2. INTRODUCTION  The eyes are frequently involved in diseases Affecting the rest of the body.  Ocular manifestations in certain multisystem Disorders may offer a diagnostic clue.
  3. 3. Eye examination  Vision  External – Look at eyelids, make sure everything looks normal.  Pupils  Relative afferent papillary defect  See if pupils are reacting normally  Motility – Have the patient look up, down, right and left.  Exam of anterior segment  Dilated ophthalmoscopy – Examine retina, optic nerve, and vessels.  Visual fields – Place you finger in different places in patient’s visual field and ask him if he sees it. Test one eye at a time.
  4. 4. INVOLVED SYSTEMIC DISEASES 1. Connective tissue diseases 2. Spondyloarthropathies 3. Digestive-inflammatory bowel disease 4. Multisystem non-infectious diseases 5. Infectious disease 6. Mucocutaneous disease 7. Cardiovascular disease 8. Endocrine-metabolic disease 9. Myopathies 10. Neurologic diseases 11. Haematological disease
  5. 5. Connective Tissue Diseases A. Rheumatoid arthritis  Keratoconjunctivitis sicca  Episcleritis  Scleritis  Peripheral ulcerative keratitis  Uveitis
  6. 6.  Rheumatoid Episcleritis  Rheumatoid Scleromalacia Perforans  Rheumatoid Corneal UlcerationRheumatoid Scleritis
  7. 7. Juvenile Idiopathic Arthritis  Idiopathic Arthritis in patients younger than 16 years and lasts at least 6 weeks.  Classification Oligo or pauciarticular Polyarticular RF + / RF- Psoriatic Enthesitis  Risk factor for uveitis Early onset female ANA + oligoarticular HLA-DR5
  8. 8. Juvenile Idiopathic Arthritis Ocular feature- 1. AU- chronic and granulomatous 2. Posterior synechia 3. Band keratopathy 4. Cataract 5. Glaucoma
  9. 9. C. Systemic Lupus Erythematosus (Lupus) Ocular feature Dry eyes  Scleritis Peripheral corneal ulcers  Retinopathy Optic neuropathy
  10. 10. D. Wegener Granulomatosis
  11. 11. E. Sjogren Syndrome
  12. 12. Sjogren Syndrome
  13. 13. F. Giant Cell Arteritis
  14. 14. G. Marfan syndrome
  15. 15. 2. Spondyloarthropathies A. Ankylosing spondylitis
  16. 16. B. Reiter syndrome/Reactive arthritis Keratoderma blennorrhagica in reactive arthritis
  17. 17. 3. Inflammatory Bowel Disease a) Crohn’s disease b)Ulcerative colitis AAU Dry eye Conjunctivitis Scleritis Episcleritis
  18. 18. 4. Multisystem noninfectious diseases A. Sarcoidosis  Respiratory symptoms  Skin lesion  Lympadenopathy  Cardiac disease  Neurologic disease
  19. 19. Sarcoidosis Ocular feature  Granulomatous anterior uveitis  Mutton fat KP  Iris nodules (koeppe / Busaca)  TM nodules  Vitrious opacities (snow ball)  Periphlebitis ( candle wax drippings)  Optic disc nodules  Dry eye  Bilaterality Very large granulomatous ‘mutton fat’ keratic precipitates
  20. 20. Sarcoidosis granulomata and periphlebitis ‘Candle wax drippings’snowballs Lacrimal gland enlargement in sarcoidosis
  21. 21. B. Behçet disease  Criteria for Behçet's disease: Mouth sores (oral ulcers) at least 3 times in 12 months Any 2 of the following: Recurring genital sores/ulcers Uveitis Skin: Pustules or erythema nodosum Positive pathergy (skin prick test) Major aphthous ulceration superficial thrombophlebitis
  22. 22. Behçet disease  Ocular feature  AAU  Vitritis  Retinitis  Retinal vasculitis  Optic disc oedama  Optic atrophy Hypopyon in a white eye occlusive vasculitis
  23. 23. C. Vogt Koyanagi Harada syndrome Vitiligo and poliosis in Vogt–Koyanagi–Harada syndrome ‘Sunset glow’ fundus
  24. 24. 5. Infectious disease A. Tuberculosis  ocular feature  Anterior uveitis – granulomatous  Vitritis  Choroidal granuloma  Choroiditis  Retnal vasculitis  Lupus vulgaris Choroidal granuloma Occlusive tuberculous periphlebitis. -Superior retinal branch occlusion
  25. 25. B. Syndrome acquired immunodeficiency (SAID) Kaposi sarcoma HIV wasting syndrome HIV microangiopathy
  26. 26. C. Syphilis  Ocular features  Anterior uveitis  Chorioretinitis  Acute syphilitic posterior placoid chorioretinopathy (ASPPC)  Retinitis  Optic neuritis and neuroretinitis  Argyll Robertson pupils Maculopapular rash in secondary disease; old multifocal chorioretinitis acute posterior placoid chorioretinitis
  27. 27. D. Toxoplasmosis  Ocular features  ‘Spill-over’ anterior uveitis  single inflammatory focus of fluffy white retinitis or retinochoroiditis (‘satellite lesion’)  Vitritis  Vasculitis  Optic disc oedema  Visual loss Typical ‘satellite’ lesion adjacent to an old scar severe vitreous haze and ‘headlight in the fog’ appearance of lesion Macular involvement
  28. 28. 6. Mucocutaneous disease A. Pemphigoid syndromes  Ocular feature  Bilateral conjunctivitis  Symblepharon  Dry eye  Trichiasis  Ankyloblepharon  Corneal opacities moderate fibrosis with forniceal shortening and symblepharon formation ankyloblepharon severe skin blistering
  29. 29. B. Stevens-Johnson syndrome Haemorrhagic lid crusting severe acute conjunctivitis pseudomembrane Corneal keratinization extensive purpuric lesions Haemorrhagic lip crusting
  30. 30. 7. Cardiovascular disease  Grade 1. Mild generalized retinal arteriolar narrowing  Grade 2. Focal arteriolar narrowing and arteriovenous nipping (copper wiring)  Grade 3. Grade 2 plus retinal haemorrhages (dot, blot, flame), hard exudates (‘macular star’) and cotton wool spots.  Grade 4. Severe grade 3 plus optic disc swelling.this is a marker of malignant hypertension.
  31. 31. Hypertensive retinopaty Generalized arteriolar attenuation focal arteriolar attenuation red-free photograph showing arteriovenous nipping copper wiring grade 3 retinopathy with macular star grade 4 hypertensive retinopathy
  32. 32. B.Carotid stenosis
  33. 33. 8. Endocrine-metabolic disease A. Diabetes mellitus Microaneurysms Dot & blot VS splinter hemorrhage Hard exudate
  34. 34. Diabetic retinopathy Hard Exudate VS Cotton Wool Spot Venous beading Intra-retinal microvascular abnormalities (IRMA)
  35. 35. Clinical Significant Macular Edema (CSME) 1 of 3 Retinal edema within 500 microns of centre fovea Hard exudates within 500 microns of fovea if ass with adjacent retinal thickening Retinal edema > 1 disc diameter, any part is within 1 disc diameter of centre of fovea
  36. 36. Diabetic retinopathy Vitreous hemorrhage Tractional retinal detachment
  37. 37. Rubeosis iridis (neovascularisation of the iris) Neovascular glaucoma
  38. 38. B. Thyroid eye disease  CLINICAL MANIFESTATION  5 main clinical manifestations of TED are: I. Soft tissue involvement (periorbital & lid swelling, conjuctival hyperemia). II. Lid retraction III. Proptosis (passive or mechanical protrusion of eye ball) IV. Optic neuropathy (serious complication – compression of optic nerve may lead to visual impairement) V. Restrictive myopathy (ocular motilty is reduced initially by inflammatory edema & later by fibrosis)
  39. 39. Thyroid eye disease moderate bilateral symmetrical lid retraction –Dalrymple sign severe bilateral lid retraction – Kocher sign right lid lag on downgaze – von Graefe sign Proptosis in thyroid eye disease
  40. 40. 9. Myopathies  A. Myasthenia gravis
  41. 41. 10. Neurologic Diseases A. Multiple Sclerosis
  42. 42. B. Neurofibromatosis Nodular plexiform neurofibroma of the eyelid axial CT image showing right proptosis with fusiform enlargement of the optic nerve due to glioma; right proptosis due to optic nerve glioma Lisch nodules
  43. 43. 11. Haematological Disease Leukemia  Ocular feature  Retinal haemorrhages and cotton wool spots  Roth spots  Peripheral retinal neovascularization  Retinal and choroidal infiltrates  Optic nerve infiltration  Visual loss  Orbital involvement  Iris thickening, iritis and pseudohypopyon
  44. 44. Leukemia Retinal haemorrhages in leukaemia. - Numerous flame haemorrhages with cotton wool spots and Roth spots large retrohyaloid haemorrhage – a separate white cell layer is evident
  45. 45. Roth spots

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ocular manifestation of systemic disease

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