Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 18 Ocular Manifestations of Systemic Diseases Lecture Notes
Ocular Manifestations of Systemic diseases
1
Acknowledgement
? Kanski's Clinical Ophthalmology, 8th Ed.(Elsevier)
? Endocrinology : Adult and Paediatric. Burch, Henry
B.; Bahn, Rebecca S.. Published January 1, 2016. ?
2016.
? Some of the images used were taken from
eyetext.net
2
Learning Objectives
? At the end of this class the students shal be able
to :
? Describe ocular signs and symptoms associated
with selected systemic diseases .
? Understand the importance of early detection of
ocular features of systemic diseases.
3
Introduction
? "The eyes are the window to the soul."
(English proverb)
? Occasional y, eye findings may be the first
indication of underlying systemic disease leading
to early diagnosis and management.
4
Question
? Identify the ocular
abnormality in the
adjoining photograph?
? What systemic
evaluation would you
do in this patient ?
5
Why do eye problems manifest in systemic forms
The eye is linked with rest of the body by-
? Development
? Blood supply
? Meninges and nerve fibres of brain
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Common Systemic Diseases affecting the Eye
? Autoimmune disorders
? Haematological abnormalities
? Infectious diseases
? Endocrine disorders
? Muscular disorders
? Inherited disorders
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Autoimmune disorders
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Rheumatoid Arthritis
a)Kerato Conjunctivitis Sicca
b)Ulcerative Keratitis
c)Acquired Superior oblique
tendon sheath syndrome
Keratoconjunctivitis Sicca
d)Scleritis
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Scleritis
Systemic Lupus Erythematosus
a) Kerato Conjunctivitis Sicca (KCS)
b) Scleritis
c) Optic Neuropathy
Raynaud phenomenon
Retinal Vasculitis
Peripheral ulcerative Keratitis
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Sarcoidosis
?30% ocular signs
Mutton fat kps
Phlebitis
Iris nodule
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Sjogren's Syndrome
Parotid enlargement
Dry fissured tongue
Dental caries
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Ankylosing Spondylitis
?Acute anterior uveitis
?Scleritis
Symptoms:
? Photophobia
? Redness
? Decreased vision
?Bilateral sclerosis
?Erosion of sacro-iliac joint
?Bony fusion of spine
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Reiter's Syndrome
Urethritis
Triad Conjunctivitis
Arthritis
Eye Signs
? Conjunctivitis
? Acute anterior uveitis
? Numular Keratitis
? Episcleritis
? Scleritis
Urethritis
? Papillitis
? Retinal vasculitis
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Behcet's Disease
Hypopyon Uveitis
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Inflammatory Bowel Disease- Ulcerative Colitis
Crohn's Disease
Ophthalmic manifestations
a)Acute anterior uveitis
b)Peripheral corneal
infiltrates
Acute anterior uveitis
c)Conjunctivitis
d)Episcleritis
e) Scleritis
f) Papillitis
g)Retinal Vasculitis
b) Peripheral corneal infiltrates
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Giant Cell Arteritis
Predilection for superficial temporal A, ophthalmic A, posterior
Ciliary & proximal vertebral A
a) AION (Arteritic)
b) Cilio-retinal Occlusion
c) Central retinal artery occlusion
d) Cotton wool spots
Giant cells & small round cells
Superficial temporal arteritis
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Vasculitis
Wegeners
granulomatosis
Polyarteritis nodosa
Dermal infarcts
Relapsing
Polychondritis
Ocular featu
re s -
a) Necrotising scleritis
b) Peripheral ulcerative Keratitis
Peripheral ulcerative keratitis
c) Occlusive retinal periarteritis
d) Peripheral ulcerative Keratitis
e) Dacryocystitis
f) Scleritis
g) Acute anterior uveitis
Dacryocystitis 18
Haematological diseases
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Haematological diseases
1) Anaemia
2) Leukaemia
3) Lymphomas
4) Sickle cell Anaemia
Ocular Presentation:
Haemorrhagic Retinopathy
"ROTHS SPOT"
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Sea fan neovascularisation in
sickle cell disesase
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Infectious diseases
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Tuberculosis
All Structures of Eye except Lens may be involved
a) Uveitis: chronic granulomatous anterior uveitis,
multifocal choroiditis
b) Eyelids: lupus vulgaris (nodules surrounded by
erythema)
c) Orbit: cellulitis,dacryoadenitis,dacryocystitis,
osteomyelitis, abscess
d) Conjunctiva: phlyctenular conjunctivitis
e) Cornea: phlyctenular keratoconjunctivitis,
interstitial keratitis (unilateral, sectorial,
superficial vascularisation)
f) Sclera: episcleritis, nodular scleritis
g) Retina: exudative retinitis, Vasculitis
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h) Optic nerve:- papilloedema, ON
Leprosy
a) Facial palsy
b) Madarosis
c) Granulomatous iritis
d) Episleritis/scleritis
e) Secondary Glaucoma
f) Cataract
Syphilis
n Congenital: Acute interstitial keratitis, Diffusely opaque cornea, salt & pepper
fundus
n Secondary : Iritis, choroiditis, and/or exudates around disc + vessels
n Tertiary: Chorioretinitis and/or diffuse neuro-retinitis and vascular sheathing
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Other Viral Infections associated with
Ocular Diseases
? Herpes zoster
? Herpes simplex
? CMV
? Rubella
? Measles
? AIDS
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AIDS
Kaposi's sarcoma-
AIDS retinopathy- 50 to 70%
most common tumour
CMV retinitis- most common
Anterior Uveitis
opportunistic infection
? Fungal
Candidiasis- Fluffy white-yellow
superficial retinal infiltrate, vitritis
? Parasitic
? Toxoplasmosis Macular scarring, retinochoroiditis, vitritis, VR
Granuloma
? Toxocariasis
? Cysticercosis Cyst
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Endocrine & Metabolic disorders
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Endocrine & Metabolic disorders
? Diabetes Mellitus
? Muco-polysaccharidoses
? Wilson's disease
? Homocystinuria
? Hyperthyroidism
? Hypothyroidism
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Diabetes mellitus
? Refractive error
? Infections
? Corneal ulcers
? Snowflake cataract
? Retinopathy
? Maculopathy
? Optic nerve papil opathy
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THYROID EYE DISEASE
Periorbital and lid swelling
Conjunctival hyperaemia
Chemosis
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Superior limbic keratoconjunctivitis
THYROID EYE DISEASE
Unilateral lid retraction & proptosis
Restrictive myopathy
Choroidal folds
Optic neuropathy
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Muscular disorders
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Muscular disorders
? Myasthenia gravis
? Muscular dystrophy
Ocular Manifestations:
a) Ptosis
b) Diplopia,
c) Ophthalmoplegia
d) Cataract
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Inherited disorders
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Marfan's Syndrome
a) Hypoplasia of dilator pupillae
b) Myopia
c) Retinal detachment
Arachnodactyly
d) Microspherophakia
e) Keratoconus
f) Cornea Plana
High-arched palate
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Ectopia lentis
Angle anomaly
Stickler Syndrome (Herditary artho-ophthalmopathy)
Retinal Detachment
[commonest
inherited cause in
children]
Flat nasal bridge
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Pseudoxanthoma elasticum
Blue sclera
Loose skin folds
Angiod streaks
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Ehlers - Danlos Syndrome type 6 (Ocular sclerotic)
Ocular fragility
Keratoconus
Hyperelasticity of skin
High myopia
RD
Hypermobility of joints
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PHACOMATOSES - Neurofibromatosus-Type I
(Von Recklinghausen disease)
?Most common phacomatosis
?Affects 1:4000 individuals
?Presents in childhood
?Gene localized to chromosome 17q11
Facial hemiatrophy-
Skeletal defects
Nodular
Caf?-au-lait spots
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Orbital lesions in NF-1
?Optic nerve glioma
?Spheno-orbital encephalocele showing
congenital absence of left greater wing
(in 15%)
of sphenoid bone
invading hypothalamus
?
Pulsating proptosis without bruit!
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Intraocular lesions in NF-1
Lisch nodules
Choroidal naevi
42
Tuberous sclerosis (Bournevil e disease)
? Autosomal dominant
? Triad - mental handicap
epilepsy
adenoma sebaceum
Adenoma sebaceum
Shagreen patches
Ash leaf spots
Retinal astrocytomas
Innocuous tumou 4
r p 3
resent 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
Round orange-red mass
Associated dilatation and
arteriole and venuole
tortuosity of feeder vessels
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Malignancy
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Malignancy
?Metastasis
From Breast, lung most common.
Usually localize to choroid but extra ocular muscles and
optic
nerve can be affected.
?Lymphoma, leukemia
Choroidal metastasis from breast
cancer
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Summary
? Ocular examination plays a significant role in
several systemic diseases/disorders.
? Ophthalmologists detect/suspect systemic illness
for the first time in a patient when they examine
the patient for Eye related complaints.
? These patients then need
Physician/Paediatrician/Neurologist/
Neurosurgeon/ Orthopaedician/Obstetrician
opinion for further management.
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Question
? Identify the condition in
the adjacent
photograph.
? What could be the
possible causes ?
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Question
? Identify the abnormality
.
? The patients condition
worsens by evening.
? What is the possible
diagnosis?
? How will you treat this
condition?
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THANK YOU
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This post was last modified on 07 April 2022