1. Ocular manifestations of systemic diseases
Dr mahmood fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE

2. Objectives
To review the normal features of the human eye and the ocular fundus.
To record the common systemic diseases affecting the eye.
To describe the ocular signs and symptoms associated
with selected systemic diseases and their serious ocular squeal.
To compare and contrast the important features of diabetic retinopathy types and the current screening guidelines.
To review the important ocular features of hypertension, thyroid disease, sarcoidosis and inflammatory conditions, malignancy and acquired immunodeficiency syndrome.

14. Hollenhorst Plaque
A Hollenhorst plaque appears as a bright, glistening, refractile plaque, usually at the bifurcation of a retinal arteriole. These have the propensity to break up and move, and may not be present at subsequent visits.
Patient previously experiencing amaurosis fugax will not exhibit retinal emboli, but may have arteriolar narrowing and sheathing.
PATHOPHYSIOLOGY The Hollenhorst plaque is an embolus composed of cholesterol that forms from an ulcerated ipsilateral carotid artery plaque. The patient frequently has concurrent hypertension and elevated cholesterol levels. The stress on the arteries induced by hypertension leads to reduced elasticity of the vessels.

15. Ocular manifestations of HIV infection

16. Retinal Manifestations of HIV Infection
BACK OF THE EYE
Retinal Microvasculopathy
CMV Retinitis
Acute Retinal Necrosis
Progressive Outer Retinal Necrosis
Toxoplasmosis Retinochoroiditis
Syphilis Retinitis
Candida Albicans Endophthalmitis

17. CMV Retinitis Most common intraocular infection with AIDS
Retinal necrosis, exudation, & hemorrhage
Treatment:
IV ganciclovir/foscarnet
Intravitreal ganciclovir/foscarnet; Ganciclovir intravitreal implant

18. Toxoplasmosis Retinitis
CD4<100

19. Syphilis
Tertiary Syphilis Need LP Rx with IV PenicilinG

20. Tuberculosis Uveitis Choroidal granulomas Periphlebitis
Granulomas = Choroidal Tubercules
An Ocular clue for Diagnosis of Tuberculosis
Cilio-retinal granuloma in TB

21. Fundus photography of a 40-year-old male with positive
Mantoux test with choroidal tuberculoma.

22. Acute central retinal artery occlusion in Adamantiades-Behçet disease
Fundus photography and fluorescein angiography. Note grossly impaired perfusion, retinal whitening and relative cilioretinal sparing.

23. Multiple Sclerosis: Optic Neuritis
50% of patients with MS will
develop Optic Neuritis
20-30% of time will be
presenting sign for MS

24. Metastatic Disease Most common intraocular malignancy in adults
May be asymptomatic
May produce decreased or distorted vision
Most common primary: Lung, Breast
10% have unknown primary
No prior history of Cancer in 25%
Metastatic Lung Cancer.

25. Sturge-Weber Syndrome:
Choroidal Hemangioma
Nevus flammeus (Port Wine Stain)

26. Systemic Medications Benign ocular conditions
Amiodarone – whorl keratopathy
Toxic Retinopathies
Thioridazine, chloroquine, hydroxychloroquine,
tamoxifen
Toxic Optic Neuropathies
Ethambutol, isoniazid

27. Hydroxychloroquine: Ophthalmic Screening
 caused by the drugs chloroquineor hydroxychloroquine,
Used for rheumatoid arthritis, SLE, etc
This eye toxicity limits long-term use of the drugs.
Both agents bind to melanin pigment in the RPE, and this may serve to concentrate the drugs or to prolong their adverse effects.
Bulls Eye Maculopathy

28. salt and pepper fundus is found in congenital syphilis, choroideremia, Leber's congenital amaurosis, rubeola, poliomyelitis, cmv retinitis.
combination of RPE loss and migration produces the "salt and pepper" fundus. The pepper may be clumpy ("bone spicular"),
Damaged RPE migrate into superficial retina. The black pigment flecks are particularly evident in the retinal mid-periphery.

29. A myopic crescent is white or grayish white moon-shaped atrophic changes of choroid develop at the temporal border of disc of myopic eyes.
 In myopia that is no longer progressing, the crescent may be asymptomatic except for its presence on ocular examination. However, in high-degree myopia, it may extend to the upper and lower borders, or form a complete ring around the optic disc and form a central scotoma.

30. Resources http://www.aao.org/theeyeshaveit/acquired/

31. Quiz …… http://ocularmanifestofsystemicdisease.weebly.com/quiz.html