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Ocular Manifestations of Systemic Diseases PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Ocular Manifestations of Systemic diseases” by Dr Ajai Agrawal.

This medical PowerPoint presentation is about systemic diseases that can have ocular manifestations, which can range from mild to severe.

Tags : Ocular Manifestations of Systemic diseases, systemic diseases

Published on : Jun 07, 2023 | Views : 1534 | Downloads : 7

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Ocular Manifestations of Systemic diseases Dr Ajai Agrawal Additional Professor, Department of Ophthalmology, AIIMS, Rishikesh. 1
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Acknowledgement Kanski’s Clinical Ophthalmology, 8th Ed.(Elsevier) Endocrinology : Adult and Paediatric. Burch, Henry B.; Bahn, Rebecca S.. Published January 1, 2016. © 2016. Some of the images used were taken from eyetext.net 2
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Learning Objectives At the end of this class the students shall be able to : Describe ocular signs and symptoms associated with selected systemic diseases . Understand the importance of early detection of ocular features of systemic diseases. 3
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Introduction "The eyes are the window to the soul." (English proverb) Occasionally, eye findings may be the first indication of underlying systemic disease leading to early diagnosis and management. 4
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Question Identify the ocular abnormality in the adjoining photograph? What systemic evaluation would you do in this patient ? 5
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The eye is linked with rest of the body by- Development Blood supply Meninges and nerve fibres of brain 6 Why do eye problems manifest in systemic forms
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Common Systemic Diseases affecting the Eye Autoimmune disorders Haematological abnormalities Infectious diseases Endocrine disorders Muscular disorders Inherited disorders 7
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Autoimmune disorders 8
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Rheumatoid Arthritis a)Kerato Conjunctivitis Sicca b)Ulcerative Keratitis c)Acquired Superior oblique tendon sheath syndrome d)Scleritis 9 Scleritis Keratoconjunctivitis Sicca
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a) Kerato Conjunctivitis Sicca (KCS) b) Scleritis c) Optic Neuropathy Systemic Lupus Erythematosus Raynaud phenomenon 10 Peripheral ulcerative Keratitis Retinal Vasculitis
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Sarcoidosis Mutton fat kps Iris nodule Phlebitis 11 30% ocular signs
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Sjogren’s Syndrome 12 Parotid enlargement Dry fissured tongue Dental caries
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Ankylosing Spondylitis Acute anterior uveitis Scleritis Symptoms: Photophobia • Redness • Decreased vision Bilateral sclerosis Erosion of sacro-iliac joint Bony fusion of spine 13
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Reiter’s Syndrome Urethritis Triad Conjunctivitis Arthritis Eye Signs Conjunctivitis Acute anterior uveitis Numular Keratitis Episcleritis Scleritis Papillitis Retinal vasculitis 14 Urethritis
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15 Hypopyon Uveitis Behcet’s Disease
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Inflammatory Bowel Disease- Ulcerative Colitis Crohn’s Disease Ophthalmic manifestations a)Acute anterior uveitis b)Peripheral corneal infiltrates c)Conjunctivitis d)Episcleritis e) Scleritis f) Papillitis g)Retinal Vasculitis 16 b) Peripheral corneal infiltrates Acute anterior uveitis
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Predilection for superficial temporal A, ophthalmic A, posterior Ciliary & proximal vertebral A a) AION (Arteritic) b) Cilio-retinal Occlusion c) Central retinal artery occlusion d) Cotton wool spots Giant Cell Arteritis Giant cells & small round cells Superficial temporal arteritis 17
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Wegeners granulomatosis Polyarteritis nodosa Relapsing Polychondritis Vasculitis Dermal infarcts Ocular features- a) Necrotising scleritis b) Peripheral ulcerative Keratitis c) Occlusive retinal periarteritis d) Peripheral ulcerative Keratitis e) Dacryocystitis f) Scleritis g) Acute anterior uveitis Peripheral ulcerative keratitis Dacryocystitis 18
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Haematological diseases 19
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Haematological diseases 1) Anaemia 2) Leukaemia 3) Lymphomas 4) Sickle cell Anaemia Ocular Presentation: Haemorrhagic Retinopathy “ROTHS SPOT” 20
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Sea fan neovascularisation in sickle cell disesase 21
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Infectious diseases 22
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Tuberculosis All Structures of Eye except Lens may be involved a) Uveitis: chronic granulomatous anterior uveitis, multifocal choroiditis b) Eyelids: lupus vulgaris (nodules surrounded by erythema) c) Orbit: cellulitis,dacryoadenitis,dacryocystitis, osteomyelitis, abscess d) Conjunctiva: phlyctenular conjunctivitis e) Cornea: phlyctenular keratoconjunctivitis, interstitial keratitis (unilateral, sectorial, superficial vascularisation) f) Sclera: episcleritis, nodular scleritis g) Retina: exudative retinitis, Vasculitis h) Optic nerve:- papilloedema, ON 23
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Leprosy a) Facial palsy b) Madarosis c) Granulomatous iritis d) Episleritis/scleritis e) Secondary Glaucoma f) Cataract Syphilis Congenital: Acute interstitial keratitis, Diffusely opaque cornea, salt & pepper fundus Secondary : Iritis, choroiditis, and/or exudates around disc + vessels Tertiary: Chorioretinitis and/or diffuse neuro-retinitis and vascular sheathing 24
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Other Viral Infections associated with Ocular Diseases Herpes zoster Herpes simplex CMV Rubella Measles AIDS 25
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AIDS Kaposi’s sarcoma- most common tumour AIDS retinopathy- 50 to 70% CMV retinitis- most common opportunistic infection Anterior Uveitis
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Fungal Candidiasis- Fluffy white-yellow superficial retinal infiltrate, vitritis Parasitic Toxoplasmosis Macular scarring, retinochoroiditis, vitritis, VR Granuloma Toxocariasis Cysticercosis Cyst 27
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Endocrine & Metabolic disorders 28
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Endocrine & Metabolic disorders Diabetes Mellitus Muco-polysaccharidoses Wilson’s disease Homocystinuria Hyperthyroidism Hypothyroidism 29
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Diabetes mellitus Refractive error Infections Corneal ulcers Snowflake cataract Retinopathy Maculopathy Optic nerve papillopathy 30
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Periorbital and lid swelling Conjunctival hyperaemia Chemosis Superior limbic keratoconjunctivitis THYROID EYE DISEASE 31
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Unilateral lid retraction & proptosis Choroidal folds Restrictive myopathy Optic neuropathy THYROID EYE DISEASE 32
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Muscular disorders 33
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Muscular disorders Myasthenia gravis Muscular dystrophy Ocular Manifestations: a) Ptosis b) Diplopia, c) Ophthalmoplegia d) Cataract 34
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Inherited disorders 35
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Marfan’s Syndrome a) Hypoplasia of dilator pupillae b) Myopia c) Retinal detachment d) Microspherophakia e) Keratoconus f) Cornea Plana Arachnodactyly 36 Ectopia lentis Angle anomaly High-arched palate
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Stickler Syndrome (Herditary artho-ophthalmopathy) Retinal Detachment [commonest inherited cause in children] Flat nasal bridge 37
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38 Pseudoxanthoma elasticum Blue sclera Loose skin folds Angiod streaks
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Ehlers - Danlos Syndrome type 6 (Ocular sclerotic) Ocular fragility Hyperelasticity of skin Hypermobility of joints High myopia RD Keratoconus 39
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PHACOMATOSES - Neurofibromatosus-Type I (Von Recklinghausen disease) Most common phacomatosis Affects 1:4000 individuals Presents in childhood Gene localized to chromosome 17q11 Café-au-lait spots Facial hemiatrophy- Skeletal defects Nodular 40
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Optic nerve glioma (in 15%) invading hypothalamus Spheno-orbital encephalocele showing congenital absence of left greater wing of sphenoid bone Pulsating proptosis without bruit! Orbital lesions in NF-1 41
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Intraocular lesions in NF-1 Lisch nodules Choroidal naevi 42
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Tuberous sclerosis (Bourneville disease) Autosomal dominant Triad - mental handicap epilepsy adenoma sebaceum Adenoma sebaceum Ash leaf spots Shagreen patches 43 Retinal astrocytomas Innocuous tumour present in 50% of patients
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Von-Hippel-Lindau syndrome Tumours– renal carcinoma and phaeochromocytoma Cysts- kidneys, liver, pancreas, epididymis, ovary and lungs Polycythaemia Retinal capillary haemangioma Tiny lesion between arteriole and venuole Round orange-red mass Associated dilatation and tortuosity of feeder vessels 44
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Malignancy 45
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Malignancy Metastasis From Breast, lung most common. Usually localize to choroid but extra ocular muscles and optic nerve can be affected. Lymphoma, leukemia
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Choroidal metastasis from breast cancer 47
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Summary Ocular examination plays a significant role in several systemic diseases/disorders. Ophthalmologists detect/suspect systemic illness for the first time in a patient when they examine the patient for Eye related complaints. These patients then need Physician/Paediatrician/Neurologist/ Neurosurgeon/ Orthopaedician/Obstetrician opinion for further management. 48
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Question Identify the condition in the adjacent photograph. What could be the possible causes ? 49
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Question Identify the abnormality . The patients condition worsens by evening. What is the possible diagnosis? How will you treat this condition? 50
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THANK YOU 51