Ocular manifestations of systemic diseases
Download
1 / 35

Ocular Manifestations of Systemic Diseases - PowerPoint PPT Presentation


  • 239 Views
  • Uploaded on

Ocular Manifestations of Systemic Diseases. Dalman. Dysthyroid Orbitopathy. autoimmune disorder usually associated with Graves' disease 10-25% euthyroid extra-ocular muscles are the target of the autoimmune attack  restrictive ophthalmoplegia and proptosis Cardinal Signs

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Ocular Manifestations of Systemic Diseases' - masato


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Dysthyroid orbitopathy
DysthyroidOrbitopathy

  • autoimmune disorder usually associated with Graves' disease

  • 10-25% euthyroid

  • extra-ocular muscles are the target of the autoimmune attack  restrictive ophthalmoplegia and proptosis

  • Cardinal Signs

    • upper eyelid retraction and lag, conjunctival injection and chemosis, and periorbital edema.


Dysthyroid orbitopathy1
DysthyroidOrbitopathy

  • Pathophysiology

    • antibody-mediated reaction against the TSH receptor with orbital fibroblast modulation of T-cell lymphocytes


Dysthyroid orbitopathy2
DysthyroidOrbitopathy

  • Pathophysiology

T- cells

inflammation

Thyroid cells

Hyperosmotic shift

Orbital fibroblast

EOM edema

cytokines

mucopolysaccharides


Dysthyroid orbitopathy3
DysthyroidOrbitopathy

  • Pathophysiology

Preadipocyte fibroblasts

adipocytes

Inc. orbital volume

Inc. fat

proptosis

lagophthalmos

edema

Tissue damage and fibrosis

EO motility restriction


Dysthyroid orbitopathy4
DysthyroidOrbitopathy


Dysthyroid orbitopathy5
DysthyroidOrbitopathy


Dysthyroid orbitopathy6
DysthyroidOrbitopathy


Dysthyroid orbitopathy7
DysthyroidOrbitopathy

  • Management

    • self-limited (over 1 year)

    • No immediate cure available


Dysthyroid orbitopathy8
DysthyroidOrbitopathy

  • Management

    • Orbital radiation

      • moderate-to-severe inflammatory symptoms, diplopia, and visual loss in patients with TAO

    • Optic nerve compression

      • High-dose steroids (proceed to surgery if unresponsive)

    • Surgical

      • Orbital decompression

      • Strabismus surgery

      • Lid lengthening

      • Blepharoplasty


Occular changes in hypertension
Occular Changes in Hypertension

  • Damage to the retina caused by high blood pressure

  • 3 manifestations

    • Hypertensive retinopathy

    • Hypertensive optic neuropathy

    • Hypertensive choroidopathy


Occular changes in hypertension1
Occular Changes in Hypertension

  • Pathophysiology

    • Retinal microvasculature

Inc BP

Hyperoxic & hypercapneic stress

Bifurcation angles and retinal arteriolar diameters show Dec vascular reactivity

Disadvantageous branching geometry in retinal vasculature


Occular changes in hypertension2
Occular Changes in Hypertension

  • Pathophysiology

    • Dynamics of ocular blood flow

Hypertensive arterial changes

Inc resistance to optic nerve head blood flow

Inc BP

Breakdown of autoregulation


Occular changes in hypertension3
Occular Changes in Hypertension

  • Pathophysiology

    • Different manifestations because

      • Acute HTN disrupts blood-retinal barriers

      • Retinal and optic nerve head vascular beds have autoregulation (choroidal has none)

      • Choroidal vessels has no blood-ocular barrier

      • Retinal vessels (no autonomic nerve supply)

      • Choroidal vessels (richly supplied by both sympathetic and parasympathetic nerves)


Hypertensive retinopathy
Hypertensive Retinopathy

  • Represents target-organ damage





Hypertensive retinopathy1
Hypertensive Retinopathy

  • Clinical features

    • Vasoconstriction

    • Fundus

      • focal and generalised arteriolar narrowing, microaneurysms, intraretinal hemorrhages, cotton-wool spots, hard exudates, optic disc swelling

      • 2o to arteriolosclerosis  arteriovenous nipping

      • Flame-shaped hemorrhages (abnormal vascular permeability)

      • Macular star (lipid deposition around the fovea)

      • Disc swelling (minimal microvascular change)



Hypertensive retinopathy2
Hypertensive Retinopathy

  • Clinical features

    • Vasoconstriction

    • Fundus

      • Untreated hypertension  hemorrhagic detachment of retina and vitreous hemorrhage


Hypertensive retinopathy3
Hypertensive Retinopathy

  • Clinical features

    • Vasoconstriction

    • Fundus

    • Secondary arteriosclerosis

      • Bonnet’s sign - banking of the venule distal to the crossing

      • Gunn’s sign - nipping of the blood column

      • Salus’ sign - displacement of the venule at right angles to the arteriole


Hypertensive retinopathy4
Hypertensive Retinopathy

  • Gunn’s sign and Bonnet’s sign


Hypertensive retinopathy5
Hypertensive Retinopathy

  • Focal arterial narrowing of the retina


Hypertensive optic neuropathy
Hypertensive Optic Neuropathy

  • Papilloedema or bilateral disc swelling

    • Grade IV hypertensive retinopathy

    • Poor prognostic sign

    • Other causes like space-occupying lesions and benign intracranial HTN should be excluded

    • Theories on the pathophysiology

      • Ischemia and raised ICP as a part of hypertensive retinopathy/enchephalopathy


Hypertensive optic neuropathy1
Hypertensive Optic Neuropathy

  • Usually resolve following control of BP, but some might develop disc pallor

  • Longstanding uncontrolled HTN  retinal nerve fiber loss


Hypertensive choroidopathy
Hypertensive Choroidopathy

  • Less well recognized than retinopathy

  • Commonly described features:

    • Choroidal vascular sclerosis

    • Elschnig spots – focal areas of degenerative retinal pigment epithelium

    • Siegrist’s streaks – linear pigment epithelial changes

      • poor prognosis


Hypertensive choroidopathy1
Hypertensive Choroidopathy

  • Elschnig spots


Management
Management

  • Control hypertension

  • Grade I and II

    • Non-urgent referral

  • Grade III

    • More urgent referral to the GP

  • Grade IV

    • Patient is in medical crisis. Patient needs immediate referral to a hospital eye casualty department


ad