1. Systemic disease in ophtlhalmology
mr niyousha. MD

2. HIV ocular manifestation
1 . HIV retinopathy
2- Opportunistic Infections

3. Ocular disease occurs in 50–75% of HIV-infected patients
The most common manifestation is HIV microvasculopathy, followed
by cytomegalovirus (CMV) retinitis, ocular toxoplasmosis, non-CMV herpetic retinitis, herpes zoster ophthalmicus (HZO), and ocular neoplasia

4. HIV microvasculopathy
Hypotheses regarding the pathogenesis of retinal microvasculopathy include :
HIV-induced increase in plasma viscosity,
HIV-related immune complex deposition

5. The clinical spectrum of HIV retinopathy includes
infarct of the nerve fiber layer (often called cotton-wool spots),
retinal hemorrhages,
telangiectasia,
lack of capillary perfusion,
vascular occlusion

9. CMV
The most common AIDS-related opportunistic infection and remains an important cause of visual morbidity.
CMV retinitis frequently occurs in AIDS patients with a CD4+ count <50
cells/uL and is the most common ocular opportunistic infection associated with AIDS

12. Toxoplasmosis Larger lesions Bilateral more common Lower inflammation
Multiple lesions

14. JIA
Pauci - articular
poly – articular
Still disease

15. JIA Eye is usually quiet . 10 – 15 % chronic uveitis
periodic ocular examination is needed.

16. Risk factors
Female
Pauci articular
ANA + RF

17. Treatment Corticosteroids Long lasting flair Mydriatic
NSAIDs and Imunomedulatory Drugs

18. Marfan Disease AD
Zonolysis
Lens Subluxation
Retinal detachment

21. The most important one to be differentiated from Marfan
syndrome is surely homocystinuria.
lens dislocation is usually
downward—atypical for Marfan syndrome

22. Marfan disease
Retinal detachment is the most serious ocular complication in Marfan syndrome.
The incidence lies between 8% and 25.6%
It is more common in the younger age, with an average age of 22 years.

24. Myastenia Gravis Auto immune disorder Female > male
3rd and 4th decade
Circulating Antibodies against Neuromuscular junction
Muscle weakness
Improvement with rest
Evening worse than morning

25. Myastenia Gravis 60% ocular manifestation is first manifestation
Ocular involvement in 90% of patients
60% ocular manifestation is first manifestation
Deteriorates by β Blocker , CCB, Aminoglycosides , Corticosteroids

26. Ocular manifestation Ptosis Unilateral and bilateral
Symmetric or nonsymmetric
Diplopia
Any kind of strabismus
Pupil involvement

27. Diagnosis Tensilon test Sleep test Ice test
Circulating auto antibodies

28. Paraclinic
CT scan of chest and neck
Search for thymoma

29. Methanol Poisoning Max serum level 30- 60 min Max toxic effect
12 – 24 hr
20 cc can cause death
15 cc can cause blindness

30. Methanol Poisoning Acidosis and vision loss
Vision loss and constricted visual field
Complete blindness

31. Methanol Poisoning Pupil reaction is reduced
Ocular Muscles paresis and ptosis may happen
Metabolic injury to optic nerve and retina
Optic disk Hyperemia

32. Treatment Gastric lavage Acidosis treatment Ethanol Hemodialysis
So methanol level is not detectable

33. Vit B mg daily
Acid folic 1mg daily
Corticosteroid 2mg/kg

34. Chloroquine Central visual loss : Maculopathy
Depends on total dosage used
Hydroxychloroquine better tolerated

35. Chloroquine Slit lamp examination Macular pigmentary changes
Examination every 6 months

36. May be Non Reversible
May progress despite halting the drug
Bull eye maculopathy

37. Corticosteroids
Cataract
Glaucoma
Hepes simplex recurrences
Keratitis

38. Hypertension
Hypertension directly affects the retinal and choroidal circulations, causing hypertensive
retinopathy and choroidopathy.
Hypertension is associated with :
acceleration of diabetic retinopathy and
increases the risk of retinal vascular occlusion,
ischemic optic neuropathy,
retinal artery macroaneurysm

39. Because hypertension is frequently asymptomatic, the presenting signs or symptoms
may be visual
Hypertensive retinopathy is the most common ophthalmic manifestation of hypertension
with a reported prevalence of 2–14% in nondiabetic adults over age 40 years
Hypertensive retinopathy is associated with increased risks of stroke, cognitive impairment, and cardiovascular death

40. Initially, retinal arteriolar constriction occurs as part of an autoregulatory mechanism.
With continued disease, breakdown of the inner blood-retinal barrier
occurs, with subsequent hemorrhages and exudates, followed by retinal edema
In advanced cases, optic nerve edema (hypertensive optic neuropathy) may ensue, which is caused by ischemia leading to axonal edema