Systemic diseases and Eye diseases The 4th Affilitated Hospital of China Medical University Eye Hospital of China Medical University

1.To understand that difficult ocular diseases may correlate to systemic diseases. 2.To understand ocular manifestations of common systemic diseases. Object

Internal diseases eye AShypertensiondiabetes Vitamin deficiency Thyroid related eye diseases tuberculosisleukemiaretinopathy

Retinal Arteriosclerosis Senile degenerative sclerosis and arteriolar sclerosis Reflecting systemic arteriosclerosis to certain extent

Arteriosclerotic retinopathy Fundus: A vessel course B caliber 、 color 、 arteriolar light reflex ； C arterio-venous nicking ； D retinal hemorrhage, exudates

Grading of chronic hypertensive retinopathy Ⅳ retinal hemorrhage,edema, hard exudates,cotton-wool spot, disc swelling Ⅲ retinal hemorrhage, edema,hard exudates, cotton- wool spot Ⅱ silverwire arteriole 、 hemorrhage 、 hard exudates Ⅰ arterial narrowing 、 wider arteriolar light reflex Significance: different prognosis Ⅰ 70% Ⅳ 1%

Grade 1 Grade 2 Grade 4

Acute hypertensive retinopathy Acute hypertensive retinopathy Pregnancy-induced Hypertension syndrome Malignant hypertension Chromaffin cell tumor nephritis

Diabetic retinopathy (DR) DR is a serious complication of diabetes and a frequent cause of blindness 50% of diabetic patients suffer from DR

Classification and grading of DR Nonproliferative DR I. Red hemorrhage (microaneurysm 、 small bleeding spot) II. Yellow exudates (hard exudate 、 small bleeding spot ) III. White cotton-wool spot (cotton-wool spot 、 hard exudate) Proliferative DR IV. Neovascularization and/or vitreous hemorrhage V. Neovascularization, fibrotic proliferation VI. Neovascularization, tractional retinal detachment

Nonproliferative diabetic retinopathy

Grade Ⅰ Grade Ⅱ Grade Ⅲ Nonproliferative DR Grading

Proliferative Diabetic retinopathy

Proliferative DR Grade Ⅳ Grade Ⅵ Grade Ⅴ

Diagnosis 1.history of diabetes: more than 5 yrs ； 2.visual acuity decreased or not ； 3.ocular signs ： microaneurysm, hemorrhage, exudates, neovascularization, fibrotic proliferation, tractional retinal detachment 4.FFA ： leakage ， telangiectasia ； 5.clincal staging :non-proliferative ， proliferative

Treatment Drug, Laser, surgery 1.Blood glucose control 2.Blood pressure control 3.Thrombosis prevention 4.Improving capillary permeability 5.Improving axial transport, repairing neural fibers 6.Vitreous hemorrhage treatment 7.Laser

Tyroid related immune orbitopathy TAO Graves ophthalmopathy Immune disease

TRIO Eye : upper lid lag and retraction proptosis diplopia 、 restricted extraocular movement conjunctival injection optic neuropathy urgent proptosis : Acute orbital hypertension

TRIO

Treatment: Correction of thyroid status Corticosteroid Immunosupression Botox A injection Radiation of pituitary gland Supportive therapy orbital decompression

Brian trauma Optic nerve duct fracture （ pupil reflex ） epidural hemotoma （ hippocampal hernia-oculomotor palsy 、 pupil reflex ） Subdural hemotoma （ intracranial pressure increases 、 papillary edema ） Skull-base fracture （ bilateral eyelid,conjunctival,subdermal bruise ） Brain trauma （ visual field 、 nerve palsy ）

Purtscher retinopathy

Retinopathy of prematurity Long time oxygen inspire, premature child Fibrovascular proliferation of avascular retina Retinal hemorrhage, vitreous hemorrhage Tractional retinal detachment Secondary glaucoma Eyeball growth retardation 、 atrophy

Syphilis Required ： I stage--- eyelid 、 conjunctival chancre II stage--- acute iridocylitis syphilitic roseola chorioretinitis stromal keratitis III stage--- Argyll Robertson pupil （ 90% ） optic atrophy （ 20% ） oculomotor palsy

congenital Stromal keratitis chorioretinitis （ peppersalt fudus ） optic atrophy Syphilis

Neurological disorders myasthenia gravis : autoimmune disease （ striated muscle ） Ach insufficiency neuromuscular conducting disorder clinical manifestation ： sudden or slow onset symptoms alleviation in the morning or after rest aggravated when continuous and repeated excerise mg neostigmine im 20-40yrs ， female

Neurological disorders Brain tumor : tumor mass ： papillary edema (high intracranial pressure) tumor compression ： visual field defect

Pupillary edema

Corticosteroid corticosteroid cataract Ballous Retinal detachment Secondary glaucoma Delayed Wound healing Reoccurrence Of Primary lesion Mild optosis Central serous chorioretinopathy Papillary / Macular edema keratitis