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. 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.
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. Behçet disease
Ocular feature AAU
Vitritis
Retinitis
Retinal vasculitis
Optic disc oedama
Optic atrophy
Hypopyon in a white eye
occlusive vasculitis
23. C. Vogt Koyanagi Harada syndrome
Vitiligo and poliosis in Vogt–Koyanagi–Harada
syndrome ‘Sunset glow’ fundus
25. B. Syndrome acquired immunodeficiency (SAID)
Kaposi sarcoma HIV wasting syndrome HIV microangiopathy
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. 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. 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. B. Stevens-Johnson syndrome
Haemorrhagic lid crusting severe acute conjunctivitis pseudomembrane
Corneal keratinization extensive purpuric lesions Haemorrhagic lip crusting
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.
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
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. 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
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. 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. 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