Download MBBS Ophthalmology PPT 34 Ocular Manifestations of Systemic Diseases Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 34 Ocular Manifestations of Systemic Diseases Lecture Notes


Ocular Manifestations of Systemic Diseases



1

Objectives of learning

? Why some systemic disorders can involve

eyes?

? What are commoner disorders you can

encounter during your clinical postings in

other specialities?

? Learn a multi-speciality , judicious cross

referral.




The eye is linked with rest of the body by-

? Development

? Blood supply

? Meninges & nerve
fibres of brain

3


Common Systemic Diseases affecting the Eye

? Autoimmune disorders
? Hematological abnormalities
? Infections
? Endocrine disorders
? Muscular disorders
? Inherited disorders

5



Auto-immune disorders

6










Rheumatoid Arthritis

a)Kerato Conjunctivitis Sicca

(Dry eye)- 25% patients

b) Ulcerative Keratitis

c) Scleritis

K C S

7

Scleritis

Systemic Lupus Erythematosus

a) Kerato Conjunctivitis Sicca

(Dry Eye)- 25% patients

b) Scleritis



Raynaud's phenomenon

c) Optic Neuropathy

Madarosis

Peripheral ulcerative Keratitis

Retinal Vasculitis

8










SARCOIDOSIS

?25-30% patients have ocular signs

Mutton fat kps

Iris nodule

Phlebitis

9

Sjogren's Syndrome

Dry Eye

in

30% Patients

Dry fissured tongue

Dental caries

Parotid enlargement

10


Bulbar conjunctiva

congestion

in Interpalpebral

area

Schirmer test

? 5mm end of 5 minutes

SIGNIFY DRY EYE
( less than 10 mm at the

end of 5 min is

suggestive of

abnormality)*


Corneal Staining

? Fluorescein Staining
? Punctate epithelial

staining present in

lower half of cornea

(interpalpebral region)

TEAR FILM BREAK UP TIME

? Less than 5 seconds ( SIGNIFY DRY EYES)
? ( less than 10 seconds is considered

abnormal)*




Ankylosing Spondylitis

?Acute anterior uveitis

(prevalence of 0.2?

1.2%) ,

? HLAB27 is +ve in

75% cases

?

?Bilateral sclerosis

Scleritis

?Erosion of s-i joint

?Bony fusion of

spine

15

Reiter Syndrome

Urethritis

Triad Arthritis

Conjunctivits

Eye Signs:

? Conjunctivitis

? Ac. anterior uveitis

? Numular Keratitis

? Episcleritis

? Scleritis

? Papillitis

? Retinal vasculitis

16








Behcet's Disease

Triad of oral aphthous ulcers, genital ulcers, and uveitis

Eye Signs:
a) Hypopyon
b) Uveitis / Iritis

17

Inflammatory Bowel Disease- Ulcerative Colitis

Crohn's Disease

Ophthalmic

manifestations:
a) Acute anterior uveitis
b) Episcleritis
c) Conjunctivitis

Acute anterior uveitis

d) Peripheral corneal infiltrates
e) Scleritis
f) Papillitis
g) Retinal Vasculitis

b) Peripheral corneal

18

infiltrates








Giant Cell Arteritis

Predilection for superficial temporal A, ophthalmic A, posterior

Ciliary & proximal vertebral A

a) AION (Arteritic)

b) TIA , Cilio-retinal Occlusion

c) Central retinal artery occlusion



Giant cells & small round cells

Superficial temporal arteritis

19

Vasculitis

?Wegener granulomatosis

?Relapsing Polyarteritis

nodosa

?Polychondritis

Dermal infarcts

Ocular features-



a) Necrotising scleritis

b) Peripheral ulcerative Keratitis

c) Occlusive retinal periarteritis

Peripheral ulcerative Keratitis

d) Peripheral ulcerative Keratitis

e) Dacryocystitis

f) Acute anterior uveitis

Dacryocystitis




Haematological diseases

Haematological diseases

1) Anaemia
2) Leukaemia
3) Lymphomas
4) Sickle cell Anaemia

Ocular Presentation:
Haemorrhagic Retinopathy
"ROTHS SPOT"


22




Hypertensive retinopathy

Infectious diseases

24




1) Tuberculosis

May involve all Structures of Eye except Lens
a) Uveitis: chronic granulomatous anterior uveitis,

multifocal choroiditis


b) Eyelids: lupus vulgaris
c) Orbit: dacryoadenitis,dacryocystitis,

osteomyelitis


d) Conjunctiva: phlyctenular conjunctivitis
e) Cornea: phlyctenular keratoconjunctivitis,

interstitial keratitis

f) Sclera: episcleritis, nodular scleritis
g) Retina: exudative retinitis, Vasculitis
h) Optic nerve:- papilloedema, ON

2) Leprosy
a) Facial palsy
b) Madarosis
c) Granulomatous iritis
d) Episleritis/scleritis
e) Secondary Glaucoma
f) Cataract

3) Syphilis
Congenital: Acute interstitial keratitis, Diffusely opaque cornea,
salt & pepper fundus
Secondary : Iritis, choroiditis, and/or exudates around
disc + vessels
Tertiary: Chorioretinitis and/or diffuse neuro-retinitis and
vascular sheathing

26




Viral Infections associated with Ocular Diseases

? Herpes zoster
? Herpes simplex
? CMV
? Rubella- cataract
? Measles
? AIDS

27

AIDS

Kaposi's sarcoma-

AIDS retinopathy- 50 to 70%

most common tumour

CMV retinitis-most common

Anterior Uveitis

opportunistic infection

28




? Fungal

Candidiasis- Fluffy white-yellow

superficial retinal infiltrate, vitritis

? Parasitic
? Toxoplasmosis : Macular scarring, retinochoriditis,
vitritis, VR Granuloma
? Toxocariasis
? Cysticercosis Cyst

29

Al India Institute of Medical Sciences,

Rishikesh

Ocular Manifestations of Systemic Diseases

[Lecture 2] Dated 10-10-2017



Dr Sanjeev Kumar Mittal

Professor & Head, Ophthalmology

30
Endocrine & Metabolic disorders

Endocrine & Metabolic disorders

? Diabetes Mellitus
? Muco-polysaccharidoses
? Wilson disease
? Homocystinuria
? Hyperthyroidism
? Hypothyroidism

32


Metabolic Cataract

Diabetes Mellitus-

? Pre-senile cataract
? Snowflake cataract
[Sorbitol accumulation in
lens due to aldose
reductase pathway

33

Metabolic Cataract

? Galactosemic Cataract

Deficiency of GPUT- Oil droplet cataract
Deficiency of Galactokinase-Lamellar Cataract
Metabolic Cataract

? Wilsons disease
Hepatolenticular degeneration
Sun flower Cataract
Kayser-Fleischer Ring

Metabolic Cataract

? Lowe's syndrome [oculo-cerebral-renal

syndrome]


inborn error of amini acid metabolism
Congenital cataract, microphakia
Posterior lenticonus, glaucoma
Metabolic Cataract

? Mannosidosis
Deficiency of alpha-mannosidase mannose rich

oligosaccharides in tissues spokes like

posterior capsular cataract

Metabolic Cataract

? Fabry's disease
Deficiency of alpha galactosidose spoke like

cataract & vortex keratopathy
? Hypocalcemia-
Decreased parathyroid activity leads to cataract

Diabetes Mellitus

? Diabetic Retinopathy
? Diabetic Maculopathy
? Corneal erosions
? Optic nerve Papillopathy
? Transient Myopia




FUNDUS

Retinopathy

Maculopathy

THYROID EYE DISEASE

Unilateral lid retraction & proptosis

42






OCULAR MOVEMENTS

Restrictive myopathy




Dalrymple Sign

Lid Retraction

Normal

Naffziger test


Exophthalmos

MRI

? Thickening of Muscle bel y

? Tendon sparing

? Radiological y both eyes

are involved


Slight straightening
of optic nerve in Right
eye

Muscular disorders




Muscular disorders

? Myasthenia gravis
? Muscular dystrophy

Ocular Manifestations:
a) Ptosis,
b) diplopia,
c) exophthalmoplegia,
d) cataract(Christmas-

tree cataract)

51

Inherited disorders

52




Marfan Syndrome

a) Ectopia lentis BE

[superior Lenticular
subluxation]

b) Microspherophakia
c) Retinal Detachment
d) Myopia
e) Keratoconus

Ectopia lentis

53

Long spider like fingers

Tall thin stature with

disproportionately long limbs

compared to trunk

? High arch palate




Sticklers Syndrome

(Herditary artho-ophthalmopathy)

?Vitreous syneresis

?Retinal Detachment



Flat nasal bridge

55

3) Pseudoxanthoma elasticum

Prevalence 1/25000

Angiod streaks

Loose skin folds

56








Osteogenesis imperfecta

1/20000 live births

Blue sclera

Ehlers - Danlos Syndrome type 6 (Ocular sclerotic)

Keratoconus

Hyperelasticity of skin

High myopia

RD

Hypermobility of joints




PHACOMATOSES - Neurofibromatosus-Type I

(Von Recklinghausen disease)

?Most common phacomatosis

?Affects 1:4000 individuals

?Presents in childhood

?Gene localized to chromosome 17q11

Nodular

Facial hemiatrophy-

Skeletal defects

Caf?-au-lait spots

3/24/2022

59

? C/O mass over right eyelid

since birth

? Growing with age
? Painless




Iris-Lisch Nodules

? LISCH

NODULES/hamartoma

? Caf? au lait spot and

axil ary freckling were

also present

Intraocular lesions in NF-1

Lisch nodules

Choroidal naevi

62






Family history

Father has multiples neurfibromas al over chest and

arm ( 1st degree relative)

Orbital lesions in NF-1

?Spheno-orbital encephalocele showing

congenital absence of left greater wing

?Optic nerve glioma(in 15%)

of sphenoid bone

invading hypothalamus

? Pulsating proptosis without bruit!



64










Tuberous sclerosis (Bournevil e disease)

? Autosomal dominant
? Triad - mental handicap,

epilepsy,

adenoma sebaceum

Adenoma sebaceum

Shagreen patches

Ash leaf spots

Retinal astrocytomas

Innocuous tumour pre65

sent in

50% of patients

Von-Hippel-Lindau syndrome

?Tumours? renal carcinoma and phaeochromocytoma
?Cysts- kidneys, liver, pancreas, epididymis, ovary and lungs
?Polycythaemia
?Retinal capil ary haemangioma

Tiny lesion between

Associated dilatation and

arteriole and venuole

Round orange-red mass

tortuosity of feeder vessels

66
Sturge-Weber syndrome

Involves face, leptomeninges and the eyes

? Arteriovenous malformations of episclera
? Choroidal haemangioma
? Glaucoma (ipsilateral)
? Iris heterochromia

Albinism

Hypopigmented skin and hair with eyes

involvement

? Nystagmus

? Translucent iris giving rise to a "pink-eyed"

appearance.

? Large choroidal vessels are seen due to lack of

pigment in fundus.

? Foveal hypoplasia
Malignancy

Malignancy

? Metastasis

? From Breast, lung most common.
? Usually localize to choroid but Extra Ocular

Muscles,
? optic nerve and orbit can also be affected

? Lymphoma, leukemia

70


Summary

? Ocular examination plays a significant role in

diagnosing several systemic illnesses.

? At times, patient present for eye related

problem, which then comes out to be a part of

systemic disease, requiring inter-departmental

reference of the case to Physician/

Paediatrician/Neurologist/ Neurosurgeon/

Orthopaedician/Obstetrician.

71

Acknowledgement

Photgraphs from Kanski, Parson and Archives Dept of

Ophthalmology AI Ms Rishikesh
1] Snow-flake cataract is seen in

a)

Diabetes

b)

Galactosemia

c)

Trauma

d) Rubella

2] Cataract associated with atopic dermatitis

a) Sunflower cataract

b) Coronary cataract

c) Shields cataract

d) Coralliform cataract

3] Sunflower type cataract is seen in

(a)

Diabetes

(b)

Chalcosis

(c)

Argyrosis

(d)

Tay sach's disease

4. Most common ocular manifestation of AIDS is:

(a) Cottonwood spots

(b) Cytomegalovirus retinitis

(c) Kaposi's sarcoma of conjunctiva

(d) Pseudotumors

5. Which prominent ocular manifestation is

associated with

Marfan's syndrome? :

(a) Microcornea

(b) Microspherophakia

(c) Megalocornea

(d) Ectopia lentis


This post was last modified on 07 April 2022