Ocular Manifestations of Systemic diseases
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1Acknowledgement
? Kanski's Clinical Ophthalmology, 8th Ed.(Elsevier)
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? Endocrinology : Adult and Paediatric. Burch, HenryB.; Bahn, Rebecca S.. Published January 1, 2016. ?
2016.
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? Some of the images used were taken from
eyetext.net
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2Learning Objectives
? At the end of this class the students shal be able
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to :? Describe ocular signs and symptoms associated
with selected systemic diseases .
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? Understand the importance of early detection of
ocular features of systemic diseases.
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3Introduction
? "The eyes are the window to the soul."
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(English proverb)? Occasional y, eye findings may be the first
indication of underlying systemic disease leading
to early diagnosis and management.
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4Question
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? Identify the ocularabnormality in the
adjoining photograph?
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? What systemic
evaluation would you
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do in this patient ?5
Why do eye problems manifest in systemic forms
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The eye is linked with rest of the body by-
? Development
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? Blood supply? Meninges and nerve fibres of brain
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Common Systemic Diseases affecting the Eye
? Autoimmune disorders
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? Haematological abnormalities
? Infectious diseases
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? Endocrine disorders? Muscular disorders
? Inherited disorders
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Autoimmune disorders8
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Rheumatoid Arthritis
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a)Kerato Conjunctivitis Siccab)Ulcerative Keratitis
c)Acquired Superior oblique
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tendon sheath syndrome
Keratoconjunctivitis Sicca
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d)Scleritis9
Scleritis
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Systemic Lupus Erythematosus
a) Kerato Conjunctivitis Sicca (KCS)
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b) Scleritisc) Optic Neuropathy
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Raynaud phenomenonRetinal Vasculitis
Peripheral ulcerative Keratitis
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Sarcoidosis?30% ocular signs
Mutton fat kps
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Phlebitis
Iris nodule
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11Sjogren's Syndrome
Parotid enlargement
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Dry fissured tongue
Dental caries
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Ankylosing Spondylitis?Acute anterior uveitis
?Scleritis
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Symptoms:
? Photophobia
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? Redness? Decreased vision
?Bilateral sclerosis
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?Erosion of sacro-iliac joint
?Bony fusion of spine
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13Reiter's Syndrome
Urethritis
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Triad Conjunctivitis
Arthritis
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Eye Signs? Conjunctivitis
? Acute anterior uveitis
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? Numular Keratitis? Episcleritis
? Scleritis
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Urethritis
? Papillitis
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? Retinal vasculitis14
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Behcet's Disease
Hypopyon Uveitis
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Inflammatory Bowel Disease- Ulcerative Colitis
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Crohn's DiseaseOphthalmic manifestations
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a)Acute anterior uveitisb)Peripheral corneal
infiltrates
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Acute anterior uveitis
c)Conjunctivitis
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d)Episcleritise) Scleritis
f) Papillitis
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g)Retinal Vasculitis
b) Peripheral corneal infiltrates
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Giant Cell Arteritis
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Predilection for superficial temporal A, ophthalmic A, posterior
Ciliary & proximal vertebral A
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a) AION (Arteritic)b) Cilio-retinal Occlusion
c) Central retinal artery occlusion
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d) Cotton wool spots
Giant cells & small round cells
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Superficial temporal arteritis17
Vasculitis
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Wegeners
granulomatosis
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Polyarteritis nodosaDermal infarcts
Relapsing
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Polychondritis
Ocular featu
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re s -a) Necrotising scleritis
b) Peripheral ulcerative Keratitis
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Peripheral ulcerative keratitis
c) Occlusive retinal periarteritis
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d) Peripheral ulcerative Keratitise) Dacryocystitis
f) Scleritis
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g) Acute anterior uveitis
Dacryocystitis 18
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Haematological diseases
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19Haematological diseases
1) Anaemia
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2) Leukaemia3) Lymphomas
4) Sickle cell Anaemia
Ocular Presentation:
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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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TuberculosisAll Structures of Eye except Lens may be involved
a) Uveitis: chronic granulomatous anterior uveitis,
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multifocal choroiditisb) Eyelids: lupus vulgaris (nodules surrounded by
erythema)
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c) Orbit: cellulitis,dacryoadenitis,dacryocystitis,osteomyelitis, abscess
d) Conjunctiva: phlyctenular conjunctivitis
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e) Cornea: phlyctenular keratoconjunctivitis,interstitial keratitis (unilateral, sectorial,
superficial vascularisation)
f) Sclera: episcleritis, nodular scleritis
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g) Retina: exudative retinitis, Vasculitis
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h) Optic nerve:- papilloedema, ONLeprosy
a) Facial palsy
b) Madarosis
c) Granulomatous iritis
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d) Episleritis/scleritise) Secondary Glaucoma
f) Cataract
Syphilis
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n Congenital: Acute interstitial keratitis, Diffusely opaque cornea, salt & pepperfundus
n Secondary : Iritis, choroiditis, and/or exudates around disc + vessels
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n Tertiary: Chorioretinitis and/or diffuse neuro-retinitis and vascular sheathing24
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Other Viral Infections associated with
Ocular Diseases
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? Herpes zoster
? Herpes simplex
? CMV
? Rubella
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? Measles? AIDS
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AIDSKaposi's sarcoma-
AIDS retinopathy- 50 to 70%
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most common tumour
CMV retinitis- most common
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Anterior Uveitisopportunistic infection
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? FungalCandidiasis- Fluffy white-yellow
superficial retinal infiltrate, vitritis
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? Parasitic? Toxoplasmosis Macular scarring, retinochoroiditis, vitritis, VR
Granuloma
? Toxocariasis
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? Cysticercosis Cyst
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Endocrine & Metabolic disorders28
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Endocrine & Metabolic disorders? Diabetes Mellitus
? Muco-polysaccharidoses
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? Wilson's disease
? Homocystinuria
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? Hyperthyroidism? Hypothyroidism
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Diabetes mellitus
? Refractive error
? Infections
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? Corneal ulcers? Snowflake cataract
? Retinopathy
? Maculopathy
? Optic nerve papil opathy
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THYROID EYE DISEASE
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Periorbital and lid swelling
Conjunctival hyperaemia
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Chemosis31
Superior limbic keratoconjunctivitis
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THYROID EYE DISEASE
Unilateral lid retraction & proptosis
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Restrictive myopathyChoroidal folds
Optic neuropathy
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Muscular disorders
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Muscular disorders? Myasthenia gravis
? Muscular dystrophy
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Ocular Manifestations:
a) Ptosis
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b) Diplopia,c) Ophthalmoplegia
d) Cataract
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Inherited disorders
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Marfan's Syndromea) Hypoplasia of dilator pupillae
b) Myopia
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c) Retinal detachment
Arachnodactyly
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d) Microspherophakiae) Keratoconus
f) Cornea Plana
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High-arched palate
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Ectopia lentisAngle anomaly
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Stickler Syndrome (Herditary artho-ophthalmopathy)
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Retinal Detachment
[commonest
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inherited cause inchildren]
Flat nasal bridge
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Pseudoxanthoma elasticum
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Blue scleraLoose skin folds
Angiod streaks
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Ehlers - Danlos Syndrome type 6 (Ocular sclerotic)
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Ocular fragility
Keratoconus
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Hyperelasticity of skinHigh myopia
RD
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Hypermobility of joints
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PHACOMATOSES - Neurofibromatosus-Type I(Von Recklinghausen disease)
?Most common phacomatosis
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?Affects 1:4000 individuals
?Presents in childhood
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?Gene localized to chromosome 17q11Facial hemiatrophy-
Skeletal defects
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Nodular
Caf?-au-lait spots
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Orbital lesions in NF-1
?Optic nerve glioma
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?Spheno-orbital encephalocele showing
congenital absence of left greater wing
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(in 15%)of sphenoid bone
invading hypothalamus
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?
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Pulsating proptosis without bruit!41
Intraocular lesions in NF-1
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Lisch nodules
Choroidal naevi
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Tuberous sclerosis (Bournevil e disease)
? Autosomal dominant
? Triad - mental handicap
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epilepsy
adenoma sebaceum
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Adenoma sebaceumShagreen patches
Ash leaf spots
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Retinal astrocytomas
Innocuous tumou 4
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r p 3resent in
50% of patients
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Von-Hippel-Lindau syndrome
?Tumours? renal carcinoma and phaeochromocytoma
?Cysts- kidneys, liver, pancreas, epididymis, ovary and lungs
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?Polycythaemia?Retinal capil ary haemangioma
Tiny lesion between
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Round orange-red massAssociated dilatation and
arteriole and venuole
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tortuosity of feeder vessels
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Malignancy
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Malignancy
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?MetastasisFrom Breast, lung most common.
Usually localize to choroid but extra ocular muscles and
optic
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nerve can be affected.?Lymphoma, leukemia
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Choroidal metastasis from breastcancer
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Summary
? Ocular examination plays a significant role in
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several systemic diseases/disorders.? Ophthalmologists detect/suspect systemic illness
for the first time in a patient when they examine
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the patient for Eye related complaints.
? These patients then need
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Physician/Paediatrician/Neurologist/Neurosurgeon/ Orthopaedician/Obstetrician
opinion for further management.
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Question
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? Identify the condition in
the adjacent
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photograph.? What could be the
possible causes ?
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Question
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? Identify the abnormality.
? The patients condition
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worsens by evening.
? What is the possible
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diagnosis?? How will you treat this
condition?
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THANK YOU
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