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Download MBBS Ophthalmology PPT 18 Ocular Manifestations of Systemic Diseases Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 18 Ocular Manifestations of Systemic Diseases Lecture Notes

This post was last modified on 07 April 2022


Ocular Manifestations of Systemic diseases



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1

Acknowledgement

? Kanski's Clinical Ophthalmology, 8th Ed.(Elsevier)

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? Endocrinology : Adult and Paediatric. Burch, Henry

B.; 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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2
Learning 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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3

Introduction

? "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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4


Question

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? Identify the ocular

abnormality 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

6

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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 disorders

8


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Rheumatoid Arthritis

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a)Kerato Conjunctivitis Sicca

b)Ulcerative Keratitis

c)Acquired Superior oblique

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tendon sheath syndrome

Keratoconjunctivitis Sicca

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d)Scleritis

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Scleritis

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Systemic Lupus Erythematosus

a) Kerato Conjunctivitis Sicca (KCS)

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b) Scleritis


c) Optic Neuropathy

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Raynaud phenomenon

Retinal 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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Sjogren'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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Reiter'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 vasculitis

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Behcet's Disease

Hypopyon Uveitis

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Inflammatory Bowel Disease- Ulcerative Colitis

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Crohn's Disease

Ophthalmic manifestations


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a)Acute anterior uveitis

b)Peripheral corneal

infiltrates

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Acute anterior uveitis

c)Conjunctivitis

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d)Episcleritis

e) 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 arteritis

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Vasculitis

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Wegeners

granulomatosis

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Polyarteritis nodosa

Dermal 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 Keratitis

e) Dacryocystitis

f) Scleritis

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g) Acute anterior uveitis

Dacryocystitis 18

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Haematological diseases

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Haematological diseases

1) Anaemia

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2) Leukaemia
3) 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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Tuberculosis

All Structures of Eye except Lens may be involved

a) Uveitis: chronic granulomatous anterior uveitis,

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multifocal choroiditis

b) 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, ON
Leprosy
a) Facial palsy
b) Madarosis
c) Granulomatous iritis

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d) Episleritis/scleritis
e) Secondary Glaucoma
f) Cataract

Syphilis

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n Congenital: Acute interstitial keratitis, Diffusely opaque cornea, salt & pepper

fundus

n Secondary : Iritis, choroiditis, and/or exudates around disc + vessels

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n Tertiary: Chorioretinitis and/or diffuse neuro-retinitis and vascular sheathing

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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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AIDS

Kaposi's sarcoma-

AIDS retinopathy- 50 to 70%

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most common tumour

CMV retinitis- most common

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Anterior Uveitis

opportunistic infection


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? Fungal

Candidiasis- 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 disorders

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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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Chemosis

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Superior limbic keratoconjunctivitis

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THYROID EYE DISEASE

Unilateral lid retraction & proptosis

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Restrictive myopathy

Choroidal 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 Syndrome

a) Hypoplasia of dilator pupillae

b) Myopia

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c) Retinal detachment

Arachnodactyly

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d) Microspherophakia

e) Keratoconus

f) Cornea Plana

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High-arched palate

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Ectopia lentis

Angle anomaly


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Stickler Syndrome (Herditary artho-ophthalmopathy)

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Retinal Detachment

[commonest

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inherited cause in

children]

Flat nasal bridge

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Pseudoxanthoma elasticum

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Blue sclera

Loose 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 skin

High 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 17q11

Facial 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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Pulsating proptosis without bruit!

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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 sebaceum

Shagreen patches

Ash leaf spots

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Retinal astrocytomas

Innocuous tumou 4

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r p 3

resent 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 mass

Associated 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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?Metastasis
From 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 breast

cancer

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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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48


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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50
THANK YOU

51

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