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

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

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

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4 NORMAL FUNDUS

5 Cardiovascular diseases

6 Flame shaped hemorrhages Cotton wool spots Hard exudates

7 Grade IV Hypertensive RetinopathyCentral 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 Diagnostic workup BP measurement Lipid profile ECG Echocardiography Carotid Doppler Consider risk factors Hypertension Carotid artery diseases Cardiac Arrhythmias Coagulopathy Cardiovascular diseases 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 retinopathyModerate non-prolifrative diabetic retinopathy Sever non-prolifrative diabetic retinopathy

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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 Third (Oculomotor) cranial nerve palsy. Diabetes Mellitus Complete 3 rd nerve palsy MAKE SURE THAT THE PUPIL IS NORMALLY REACTING IN 3 RD NERVE PALSY

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

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

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19 Lid lag on down gaze movement

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

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

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

24 Inflammatory conditions (Sarcoidosis) Idiopathic multisystem disorder Characterised by non-caseating granuloma More common in women 20-50 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 New vessel formationSea fan neovascularizationHyphema

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

28 Metastatic renal cell carcinomaMetastatic lymphoma Metastatic lung cancer Metastasis

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

30 Eyelid neurofibromas in NF-1 NodularPlexiform May cause mechanical ptosisMay be associated with glaucoma

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

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

33 Peripheral corneal involvement in Rheumatoid arthritis,Wegener granulomatosis, polyarteritis nodosa 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 Without inflammationWith inflammation

34 GIANT CELL ARTERITIS 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 Systemic signs & symptoms

35 Systemic infections Tuberculosis Syphilis HIV Toxoplasmosis Brucellosis Herpes zoster Candida infection Can affect any part of the eye 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.

36 Systemic infections Retinitis with vasculitis Endogenous endophthalmitis

37 Systemic infections Herpes Zoster Ophthalmicus Anterior Uveitis


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