Presentation is loading. Please wait.

Presentation is loading. Please wait.

THE EYE & THE BODY Ocular Manifestations of Systemic Diseases Dr.Turki AL-Turki Consultant Ophthalmlogist.

Similar presentations

Presentation on theme: "THE EYE & THE BODY Ocular Manifestations of Systemic Diseases Dr.Turki AL-Turki Consultant Ophthalmlogist."— Presentation transcript:

1 THE EYE & THE BODY Ocular Manifestations of Systemic Diseases Dr.Turki AL-Turki Consultant Ophthalmlogist




5 Cardiovascular diseases

6 Flame shaped hemorrhages
Cotton wool spots Hard exudates Flame shaped hemorrhages

7 Grade IV Hypertensive Retinopathy
Central retinal vein occlusion Branch retinal vein occlusion Second most common cause of vascular-related visual loss. Risk factors Hypertension Coagulopathy Vasculitis (Behcets,sarcoidosis,AIDS,SLE)

8 Cardiovascular diseases
Diagnostic workup BP measurement Lipid profile ECG Echocardiography Carotid Doppler Consider risk factors Hypertension Carotid artery diseases Cardiac Arrhythmias Coagulopathy Central retinal artery occlusion OCULAR EMERGENCY

9 Diabetes Mellitus A cause of 4000 new case of blindness/year.
Risk factors Family history Duration of disease Type of DM Use of insulin Poor metabolic control Presence of Co-morbid conditions Hypertension Hyperlipidemia Renal disease Smoking Alcohol consumption Anemia Obesity Pregnancy

10 Mild non-prolifrative diabetic retinopathy
Moderate non-prolifrative diabetic retinopathy Sever non-prolifrative diabetic retinopathy


12 Proliferative diabetic retinopathy

13 Tractional retinal detachment

14 Argon laser pan-retinal photocoagulation (PRP).
Focal laser treatment for macular edema. Intravitreal injection of steroids Intravitreal injections of anti-vascular endothelial growth factor (Anti-VEGF)

15 Diabetes Mellitus Third (Oculomotor) cranial nerve palsy.

16 Unilateral lid retraction Bilateral lid retraction
Thyroid eye disease Unilateral lid retraction Unilateral proptosis Bilateral lid retraction Bilateral proptosis In 50% of cases

17 Thyroid eye disease 1. Soft tissue involvement 2. Eyelid retraction
Periorbital and lid swelling Conjunctival hyperemia Chemosis Superior limbic keratoconjunctivitis 2. Eyelid retraction 3. Proptosis 4. Optic neuropathy 5. Restrictive myopathy


19 Lid lag on down gaze movement

20 Proptosis Occurs in about 50%
not influenced by treatment of hyperthyroidism Axial and permanent in about 70% May be associated with choroidal folds Treatment options Systemic steroids Radiotherapy Surgical decompression

21 keratoconjunctivitis
Soft tissue involvement Periorbital and lid swelling Conjunctival hyperaemia Superior limbic keratoconjunctivitis Chemosis

22 Optic neuropathy Occurs in about 5% Early defective colour vision
Usually normal disc appearance Caused by optic nerve compression at orbital apex by enlarged recti muscles Often occurs in absence of significant proptosis

23 Restrictive myopathy Occurs in about 40% Due to fibrotic contracture
Elevation defect - most common Abduction defect - less common Depression defect -uncommon Adduction defect - rare

24 Inflammatory conditions
(Sarcoidosis) Idiopathic multisystem disorder Characterised by non-caseating granuloma More common in women yrs More common in blacks and Asians Eyes – 30%

25 Inflammatory conditions
(Sarcoidosis) Anterior segment lesions (30%) Conjunctival granuloma Acute or chronic uveitis Lacrimal gland involvement& dry eye Posterior segment lesions (20%) Patchy venous sheathing Cellular infiltrate around vessels Chorioretinal granulonmas Vasculitis Neovascularisation Infiltrate in vitreous (vitritis)

26 Sickle cell retinopathy
Hyphema New vessel formation Sea fan neovascularization

27 White centered hemorrhage (Roth’s spot)
Leukemia Sterile hypopyon White centered hemorrhage (Roth’s spot)

28 Metastatic lung cancer
Metastasis Metastatic lung cancer Metastatic renal cell carcinoma Metastatic lymphoma

29 Increase in size and number throughout
Neurofibromatosis type-1 (NF-1) Café-au-lait spots Most common phacomatosis Affects 1:4000 individuals Presents in childhood Appear during first year of life Increase in size and number throughout childhood

30 Eyelid neurofibromas in NF-1
Nodular Plexiform May cause mechanical ptosis May be associated with glaucoma

31 Intraocular lesions in NF-1
Lisch nodules Congenital ectropion uveae Very common - eventually present in 95% of cases Uncommon - may be associated with glaucoma Choroidal naevi Retinal astrocytomas Rare - identical to those seen in tuberous sclerosis Common - may be multifocal and bilateral

32 Common - combined hamartomas of RPE
Ocular features of NF-2 Very common - presenile cataract Common - combined hamartomas of RPE and retina

33 Peripheral corneal involvement in
Rheumatoid arthritis,Wegener granulomatosis, polyarteritis nodosa Without inflammation With inflammation Chronic and asymptomatic Circumferential thinning with intact epithelium (‘contact lens cornea’) Acute and painful Circumferential ulceration and infiltration Treatment - systemic steroids and/or cytotoxic drugs

34 GIANT CELL ARTERITIS Systemic signs & symptoms Headache
Scalp tenderness Thickened temporal arteries Jaw claudication Acute visual loss Weight loss, anorexia, fever, night sweats, malaise & depression Ocular Complications Transient monocular visual loss (amaurosis fugax) Visual loss due to Central retinal artery occlusion (CRAO) or Anterior ischaemic optic neuropathy (AION) Visual field defects

35 Systemic infections Can affect any part of the eye Tuberculosis
Lids optic nerve. Can be limited to the eye only Difficult Dx Requires systemic antimicrobial therapy PLUS Steroids Can cause severe visual loss secondary to inflammation and infection. Tuberculosis Syphilis HIV Toxoplasmosis Brucellosis Herpes zoster Candida infection

36 Retinitis with vasculitis Endogenous endophthalmitis
Systemic infections Retinitis with vasculitis Endogenous endophthalmitis

37 Systemic infections Anterior Uveitis Herpes Zoster Ophthalmicus

Download ppt "THE EYE & THE BODY Ocular Manifestations of Systemic Diseases Dr.Turki AL-Turki Consultant Ophthalmlogist."

Similar presentations

Ads by Google