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Ocular Manifestations of Systemic Disease

Ocular Manifestations of Systemic Disease. Introduction. OCULAR MANIFESTATIONS. SYSTEMIC DISEASES. Congenital Traumatic Vascular Neoplastic Autoimmune Idiopathic Infectious Metabolic/Endocrine Drugs/Toxins. Introduction. CATEGORIES OF SYSTEMIC DISEASE. Vision External Pupils

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Ocular Manifestations of Systemic Disease

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  1. Ocular Manifestations of Systemic Disease


  3. Congenital Traumatic Vascular Neoplastic Autoimmune Idiopathic Infectious Metabolic/Endocrine Drugs/Toxins Introduction CATEGORIES OF SYSTEMIC DISEASE

  4. Vision External Pupils • Relative afferent pupillary defect Motility Anterior segment exam Dilated ophthalmoscopy Visual fields Introduction EYE EXAMINATION

  5. Down syndrome Marfan syndrome Myotonic dystrophy Tuberous sclerosis Neurofibromatosis Congenital metabolic disorders • Lysosomal storage • Carbohydrate metabolism Congenital Disorders CONGENITAL DISORDERS

  6. NEUROFIBROMATOSIS NF1 Café-au-lait spots Iris Lisch nodules Congenital Disorders

  7. Traumatic Disorders Shaken baby syndrome: multiple retinal hemorrhages


  9. Vascular Disorders Malignant hypertension

  10. Embolic Disease Sites of emboli to the ophthalmic circulation Cholesterol embolus (Hollenhurst plaque) Vascular Disorders

  11. Vascular Disorders Left eye with superotemporal branch retinal artery occlusion

  12. CRAO “Cherry red spot” in CRAO Normal fundus Vascular Disorders

  13. Monocular dimming of vision Temporary arterial obstruction Sudden, transient, painless visual loss Vascular Disorders AMAUROSIS FUGAX"Fleeting Blindness"

  14. Cardiovascular Cerebrovascular Ophthalmologic Vascular Disorders AMAUROSIS FUGAX: A MULTIDISCIPLINARY EVALUATION

  15. Vascular Disorders Talc embol in IV drug abuser

  16. Vascular Disorders Central retinal vein occlusion (CRVO)

  17. Vascular Disorders MIGRAINE:VISUAL SYMPTOMS • Scintillations • Transient obscuration of vision • Transient homonymous hemifield loss Transient homonymous hemianopia Left eye Right eye Scintillations

  18. With headache • Classic • Common • Complicated Without headache • Acephalgic Vascular Disorders MIGRAINE: TYPES

  19. Prevent frequent attacks Examine for visual loss Consider discontinuing oral contraceptives Vascular Disorders MIGRAINE: TREATMENT

  20. Hyperviscosity syndromes Thrombocytopenia Anemia, including sickle cell anemia Vascular Disorders BLOOD DYSCRASIASWITH OCULAR MANIFESTATIONS

  21. Amaurosis fugax Permanent visual loss Vascular Disorders HYPERVISCOSITY SYNDROMES:OCULAR SYMPTOMS

  22. Vascular Disorders Hyperviscosity dilated retinal veins, retinal hemorrhages, and disc edema

  23. Vascular Disorders Leukemia

  24. Vascular Disorders Leukemic infiltration of the optic nerve

  25. HbSC disease (most common form) HbSS disease Sickle thalassemia Vascular Disorders SICKLE CELL RETINOPATHY

  26. SICKLE CELL ANEMIA Retinal arterial occlusions “Sea fan” neovascularization Vascular Disorders

  27. Primary ocular melanoma Large cell lymphoma Metastatic carcinoma Neoplastic Disorders MALIGNANT NEOPLASMSINVOLVING THE EYE

  28. Most common intraocular malignancy in adults May be asymptomatic May produce decreased or distorted vision Neoplastic Disorders METASTATIC CARCINOMA

  29. Neoplastic Disorders Iris metastasis from lung carcinoma

  30. Neoplastic Disorders Choroidal metastasis from breast cancer

  31. Neoplastic Disorders Ophthalmologists shouldmonitor ocular metastasesat regular intervals.

  32. Connective tissue diseases Thyroid eye disease Myasthenia gravis Autoimmune Disorders AUTOIMMUNE DISORDERS

  33. Dry eyes are the most common manifestation (keratoconjunctivitis sicca) Symptoms • Burning • Foreign-body sensation • Photophobia Autoimmune Disorders CONNECTIVE TISSUE DISORDERS

  34. Dry eyes Dry mouth  Connective tissue disorder Specific antibodies Autoimmune Disorders SJÖGREN’S SYNDROME

  35. Artificial tears Lubricating ointment at night Punctual occlusion Environmental modification Topical anti-inflammatory agents Autoimmune Disorders DRY EYES: TREATMENT

  36. Autoimmune Disorders Severe tear deficiency: corneal ulceration and perforation

  37. ANKYLOSING SPONDYLITIS: OCULAR SYMPTOMS • Photophobia • Redness • Decreased vision If iritis, refer for evaluation and treatment. Autoimmune Disorders

  38. Autoimmune Disorders Topical corticosteroids may lead to serious ocular complications.

  39. Dry eyes Episcleritis Scleritis Corneal ulcers Uveitis Autoimmune Disorders RHEUMATOID ARTHRITIS: OCULAR MANIFESTATIONS

  40. Autoimmune Disorders Episcleritis

  41. Autoimmune Disorders Scleritis

  42. Autoimmune Disorders Scleritis Necrotizing scleritis

  43. Autoimmune Disorders Scleromalacia perforans

  44. Autoimmune Disorders Peripheral corneal ulceration

  45. Autoimmune Disorders Juvenile rheumatoid arthritis: band keratopathy

  46. Few symptoms or signs Usually chronic Secondary cataract and glaucoma Refer for periodic ophthalmic screening. Autoimmune Disorders IRITIS IN JUVENILERHEUMATOID ARTHRITIS

  47. Dry eyes Scleritis Peripheral corneal ulcers Retinopathy and optic neuropathy Autoimmune Disorders SYSTEMIC LUPUS ERYTHEMATOSUS: OCULAR MANIFESTATIONS

  48. Autoimmune Disorders Systemic lupus erythematosis: Cotton wool spots and hypertensive retinopathy

  49. Autoimmune Disorders Systemic lupus erythematosis: optic nerve involvement

  50. Dry eyes Corneal ulcers Scleritis Hypertensive retinopathy Retinal vasculitis Autoimmune Disorders POLYARTERITIS NODOSA:OCULAR MANIFESTATIONS

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