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

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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 ?

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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 disorders

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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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?

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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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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

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