Dr mahmood fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE

 To review the normal features of the human eye and the ocular fundus.  To record the common systemic diseases affecting the eye.  To describe the ocular signs and symptoms associated with selected systemic diseases and their serious ocular squeal.  To compare and contrast the important features of diabetic retinopathy types and the current screening guidelines.  To review the important ocular features of hypertension, thyroid disease, sarcoidosis and inflammatory conditions, malignancy and acquired immunodeficiency syndrome.

 BACK OF THE EYE Retinal Microvasculopathy CMV Retinitis Acute Retinal Necrosis Progressive Outer Retinal Necrosis Toxoplasmosis Retinochoroiditis Syphilis Retinitis Candida Albicans Endophthalmitis

 Most common intraocular infection with AIDS  Retinal necrosis, exudation, & hemorrhage  Treatment:  IV ganciclovir/foscarnet  Intravitreal ganciclovir/foscarnet; Ganciclovir intravitreal implant

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Tertiary Syphilis Need LP Rx with IV PenicilinG

Uveitis Choroidal granulomas Periphlebitis Granulomas = Choroidal Tubercules Cilio-retinal granuloma in TB An Ocular clue for Diagnosis of Tuberculosis

Fundus photography of a 40-year-old male with positive Mantoux test with choroidal tuberculoma.

Acute central retinal artery occlusion in Adamantiades-Behçet disease Fundus photography and fluorescein angiography. Note grossly impaired perfusion, retinal whitening and relative cilioretinal sparing.

 Most common intraocular malignancy in adults  May be asymptomatic  May produce decreased or distorted vision  Most common primary: Lung, Breast  10% have unknown primary  No prior history of Cancer in 25% Metastatic Lung Cancer.

Sturge-Weber Syndrome: Choroidal Hemangioma Nevus flammeus (Port Wine Stain )

 Benign ocular conditions Amiodarone – whorl keratopathy  Toxic Retinopathies Thioridazine, chloroquine, hydroxychloroquine, tamoxifen  Toxic Optic Neuropathies Ethambutol, isoniazid

DRUGS CAUSING RETINAL TOXICITY  DIGITALIS – ABNORMAL COLOUR VISION  ETHOMBUTOL,QUININE- OPTIC-NEUROPATHY  CHLOROQUINE – BULLS EYE MACULOPATHY RETINAL DEGENERATION  PHENOTHIAZINE – PIGMENTARY RETINOPATHY AND RETINAL EDEMA  TAMOXIFEN – PIGMENTARY RETINOPATHY

 Caused by the Drugs Chloroquine or hydroxychloroquine,  Used for rheumatoid arthritis, SLE, etc  This eye toxicity limits long-term use of the drugs.  Drug bind to melanin pigment in the RPE, and this may serve to concentrate the drugs or to prolong their adverse effects.

 Salt and Pepper Fundus is found in Congenital syphilis, choroideremia, Leber's congenital amaurosis, rubeola, poliomyelitis, cmv retinitis.  combination of RPE loss and migration produces the "salt and pepper" fundus. The pepper may be clumpy ("bone spicular"),  Damaged RPE migrate into superficial retina. The black pigment flecks are particularly evident in the retinal mid-periphery.

 A Myopic Crescent is white or grayish white moon- shaped atrophic changes of choroid develop at the temporal border of disc of myopic eyes.  In myopia that is no longer progressing, the crescent may be asymptomatic except for its presence on ocular examination. However, in high- degree myopia, it may extend to the upper and lower borders, or form a complete ring around the optic disc and form a central scotoma.myopiaoptic disccentral scotoma

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