Eye Manifest as Ion of Systemic Diseases

8/14/2019 Eye Manifest as Ion of Systemic Diseases

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Eye Manifestasion of

Systemic DiseasesByDr.Ahmed Noureldin Ahmed

MBBS,DCH,DTM&HUmm-Ghoilina H.C


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Anatomy.


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Anatomy.


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Uveal Tract

Consists of :1-Iris

2-Ciliary Body3-Choroid


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Cross section.


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Anterior Uveitis.


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Uveitisis related to a disease or infection in another part of the body such as arthritis, TB ,$ , ankylosingspondylitis, Reiters syndrome, toxoplasmosis,histoplasmosis, cytomegalovirus (CMV),

sarcoidosis, and toxocariasis.nfection of some parts of the body (tonsils, sinus,

kidney, gallbladder, and teeth) also can causeinflammation of the iris or of the entire uveal tract.


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Symptoms of IritisPhotophobia and ciliary injection of straightdeep vessels radiating from the limbus.The pupil is small and poorly reactive

because of inflammation and distant visionmay be impaired. On slit lampexamination, white precipitates can bevisualized on the posterior surface of thecornea, and inflammatory cells in theanterior chamber. Topical anesthetic will

not relieve pain.


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TreatmentSteroids and anti-inflammatory drops are

prescribed to reduce inflammation in theeye. Dilating drops also make the eyemore comfortable by relaxing the muscle

that constricts the pupil..Iritis must be treated to avoid permanent

problems such as scarring inside theeye.


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Ankylosing Sponylitisa common cause of anterior uveitis,produces eye pain, redness, photophobia,and decreased vision, usually in one eye.

There is an association with HLA-B27 -associated diseases, including psoriaticarthritis, inflammatory bowel disease, andReiter's syndrome, which includes thetriad of conjunctivitis/uveitis, arthritis,and urethritis .Treatment is with local

corticosteroids and cycloplegics.


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Juvenile Rheumatoid Arthritiscauses chronic bilateral iridocyclitis. it doesnot produce pain, photophobia, andconjunctival injection and has, therefore,been called the white iritis. more than 80%have a positive ANA titer .Inflammatoryexacerbations require treatment with local

corticosteroids and cycloplegics.


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Behet's syndromesevere anterior uveitis with hypopyon, retinalvasculitis, and optic neuritis.The clinical courseis usually severe, with multiple recurrences. The

associated systemic manifestations, such as oralaphthous ulcers or genital ulcers; erythemanodosum; thrombophlebitis; or epididymitisTreatment with local and systemic corticosteroidsalong with cycloplegics may alleviate intraocular

inflammation.Cyclosporin may be given.


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Macula.


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Age-Related Macular Degeneration )ARMD(

Most common cause of vision loss over age 65.symptoms can include blurred vision, imagedistortion (metamorphopsia), central scotoma,and trouble reading. Risk factors: age, familyhistory, cardiovascular disease, smoking, UVlight, blue eyes, and antioxidant vitamin

deficiency.


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TreatmentAntioxidant supplements may help preventARMD.

Patients above age 65 should see an eyedoctor annually and use an Amsler gridperiodically to self check for vision

problems.

Laser photocoagulation in can reducesevere vision loss


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Scleritisis an inflammatory disease that affects theConjunctiva , sclera and episclera

It is associated with underlying systemicdiseases in about half of the cases.The diagnosis of scleritis may lead to the

detection of underlying systemic disease.Rarely, scleritis is associated with aninfectious problem.


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Scleritis.


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TreatmentScleritis is treated with oral steroid andNSAIDs to reduce inflammation. Eyedrops alone do not provide adequatetreatment. In very severe cases of necrotizing scleritis, surgery may berequired to graft scleral or corneal tissue

over the area of thinned sclera


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Diabetic eye DiseaseDiabetes can affect the eyes in a number of ways. Themost common and characteristic isDiabetic Retinopathy.

Other forms of diabetic Eye disease; The Lens : may be affected by reversible osmoticchanges in patients with acute hyperglycaemia,causing blurred vision or by cataract.

Rubiosis Iridis: as a late complication of diabeticretinopathy and can cause glaucoma.6th nerve Palsy : due to mononeuropathy


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Background retinopathy

.


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Features of Diabetic Eye Diseasea) Normal Macula and Optic Disc

b) Dot and blot hge

(early background retinopathy(c( Hard Exudates

)Background Retinopathy(

d( Multiple Cotton wool Spots )Preproliferative Retinopathy.(


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Features of Diabetic Eye Disease

.


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Features of Diabetic Eye Disease

e) New Vessel formation(Advanced Retinopathy)

f) Exudative Maculopathy

g) Central Cataract

h) Cortical Cataract


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Pathological Changes

.


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Diabetic RetinopathyThe first abnormality visible through theophthalmoscope is the appearance of dot'haemorrhages', which are actually due to

capillary microaneurysms. Leakage of blood intothe deeper layers of the retina produces thecharacteristic 'blot' haemorrhage, whileexudation of fluid rich in lipids and protein give

rise to hard exudates. These have a brightyellowish white colour and are often irregular in

outline with a sharply defined margin..


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Diabetic RetinopathyBackground retinopathy does not in itself constitute a threat

to vision but may progress to two other distinct forms: maculopathy or proliferative retinopathy . Both are due

to damage to retinal vessels and resultant ret.ischemia

This may lead to blindness and affects the older patientwith type 2 diabetes . Macular oedema is the first featureof maculopathy and may in itself result in permanentmacular damage if not treated early. The first, and only,sign of this is deteriorating visual acuity and this earlycondition cannot be diagnosed with standardophthalmoscopy. This is why it is essential to screen

patients regularly for changes in visual acuity..


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Pre-ProliferativeProgressive retinal ischaemia will, in somepatients, cause background retinopathy toprogress to pre-proliferative, sight-threateningretinopathy. The earliest sign is the appearanceof 'cotton-wool spots. Cotton-wool spots aregreyish white, and a dull matt surface, unlike

the glossy appearance of hard exudates..


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Proliferative retinopathyHypoxia is the signal for formation of newvessels. These lie superficially or growforward into the vitreous.

With advanced retinopathy, haemorrhagescan be preretinal or into the vitreous.vitreous haemorrhage presents as a lossof vision in one eye, sometimes noticed onwaking, or as a floating shadow affecting

the field of vision.


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Normal Lens.


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CataractSenile Cataract : develops earlier in diabetic

patients than in the remainder of the population.Juvenile Cataract: are diffuse, rapidly

progressive cataracts associated with verypoorly controlled diabetes.They should be distinguished from temporarylens changes that occasionally appear during

hyperosmolar states and resolve when thehyperglycaemia is brought under control.


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Cataract.


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Examinationsystematic examination of the eye isessential. Visual acuity and eyemovements are tested, the pupils aredilated with a mydriatic such astropicamide 0.5%. but should not be used,in patients with a history of glaucoma.

The ophthalmologic examination begins atarm's length.


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Early referral to an


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Early referral to anophthalmologist is essential in

the following:-1-Deteriorating Visual Acuity.

2-Hard Exudate encroaching on the Macula

3-pre-proliferative changes )cotton-woolspots or venous beading(

4-new vessel formation


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Hypertensive Retinopathy

Cotton wool Spots and Flame shaped hge.
http://www.kumarandclark.com/content/body.cfm?xrefID=P0611


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4-what is this?

.


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5-What is this?

.


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6-What is this?

.


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Answers4-Proliferative retinopathy

5-Non-proliferative Retinopathy

6-Pre-Proliferative Retinopathy 7-Acute Congestive Gjaucoma


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Eye Manifest as Ion of Systemic Diseases