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


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

6


Common Systemic Diseases affecting the Eye

? Autoimmune disorders

? Haematological abnormalities

? Infectious diseases

? Endocrine disorders

? Muscular disorders

? Inherited disorders

7



Autoimmune disorders

8










Rheumatoid Arthritis

a)Kerato Conjunctivitis Sicca

b)Ulcerative Keratitis

c)Acquired Superior oblique

tendon sheath syndrome

Keratoconjunctivitis Sicca

d)Scleritis

9

Scleritis

Systemic Lupus Erythematosus

a) Kerato Conjunctivitis Sicca (KCS)

b) Scleritis


c) Optic Neuropathy

Raynaud phenomenon

Retinal Vasculitis

Peripheral ulcerative Keratitis

10








Sarcoidosis

?30% ocular signs

Mutton fat kps

Phlebitis

Iris nodule

11

Sjogren's Syndrome

Parotid enlargement

Dry fissured tongue

Dental caries

12




Ankylosing Spondylitis

?Acute anterior uveitis

?Scleritis

Symptoms:

? Photophobia

? Redness

? Decreased vision

?Bilateral sclerosis

?Erosion of sacro-iliac joint

?Bony fusion of spine

13

Reiter's Syndrome

Urethritis

Triad Conjunctivitis

Arthritis

Eye Signs
? Conjunctivitis

? Acute anterior uveitis

? Numular Keratitis

? Episcleritis

? Scleritis

Urethritis

? Papillitis

? Retinal vasculitis

14




Behcet's Disease

Hypopyon Uveitis

15

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

16








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

17

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

19

Haematological diseases

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

Ocular Presentation:
Haemorrhagic Retinopathy
"ROTHS SPOT"


20


Sea fan neovascularisation in

sickle cell disesase

21

Infectious diseases

22




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

23

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

24




Other Viral Infections associated with

Ocular Diseases

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

25

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

27

Endocrine & Metabolic disorders

28


Endocrine & Metabolic disorders

? Diabetes Mellitus

? Muco-polysaccharidoses

? Wilson's disease

? Homocystinuria

? Hyperthyroidism

? Hypothyroidism

29

Diabetes mellitus

? Refractive error
? Infections
? Corneal ulcers
? Snowflake cataract
? Retinopathy
? Maculopathy
? Optic nerve papil opathy

30












THYROID EYE DISEASE

Periorbital and lid swelling

Conjunctival hyperaemia

Chemosis

31

Superior limbic keratoconjunctivitis

THYROID EYE DISEASE

Unilateral lid retraction & proptosis

Restrictive myopathy

Choroidal folds

Optic neuropathy

32




Muscular disorders

33

Muscular disorders

? Myasthenia gravis

? Muscular dystrophy

Ocular Manifestations:

a) Ptosis

b) Diplopia,

c) Ophthalmoplegia

d) Cataract

34




Inherited disorders

35

Marfan's Syndrome

a) Hypoplasia of dilator pupillae

b) Myopia

c) Retinal detachment

Arachnodactyly

d) Microspherophakia

e) Keratoconus

f) Cornea Plana

High-arched palate

36

Ectopia lentis

Angle anomaly






Stickler Syndrome (Herditary artho-ophthalmopathy)

Retinal Detachment

[commonest

inherited cause in

children]

Flat nasal bridge

37

Pseudoxanthoma elasticum

Blue sclera

Loose skin folds

Angiod streaks

38












Ehlers - Danlos Syndrome type 6 (Ocular sclerotic)

Ocular fragility

Keratoconus

Hyperelasticity of skin

High myopia

RD

Hypermobility of joints

39

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

40






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!

41

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

44
Malignancy

45

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

47

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.

48


Question

? Identify the condition in

the adjacent

photograph.

? What could be the

possible causes ?

49

Question

? Identify the abnormality

.

? The patients condition

worsens by evening.

? What is the possible

diagnosis?

? How will you treat this

condition?

50
THANK YOU

51

This post was last modified on 07 April 2022