1. THE EYE & THE BODY
Ocular Manifestations of Systemic Diseases Dr.Turki AL-Turki Consultant Ophthalmlogist

4. NORMAL FUNDUS

5. Cardiovascular diseases

6. Flame shaped hemorrhages
Cotton wool spots
Hard exudates
Flame shaped hemorrhages

7. Grade IV Hypertensive Retinopathy
Central retinal vein occlusion
Branch retinal vein occlusion
Second most common cause of vascular-related visual loss.
Risk factors
Hypertension
Coagulopathy
Vasculitis (Behcets,sarcoidosis,AIDS,SLE)

8. Cardiovascular diseases
Diagnostic workup
BP measurement
Lipid profile
ECG
Echocardiography
Carotid Doppler
Consider risk factors
Hypertension
Carotid artery diseases
Cardiac Arrhythmias
Coagulopathy
Central retinal artery occlusion
OCULAR EMERGENCY

9. Diabetes Mellitus A cause of 4000 new case of blindness/year.
Risk factors
Family history
Duration of disease
Type of DM
Use of insulin
Poor metabolic control
Presence of Co-morbid conditions
Hypertension
Hyperlipidemia
Renal disease
Smoking
Alcohol consumption
Anemia
Obesity
Pregnancy

10. Mild non-prolifrative diabetic retinopathy
Moderate non-prolifrative diabetic retinopathy
Sever non-prolifrative diabetic retinopathy

12. Proliferative diabetic retinopathy

13. Tractional retinal detachment

14. Argon laser pan-retinal photocoagulation (PRP).
Focal laser treatment for macular edema.
Intravitreal injection of steroids
Intravitreal injections of anti-vascular endothelial growth factor (Anti-VEGF)

15. Diabetes Mellitus Third (Oculomotor) cranial nerve palsy.
MAKE SURE THAT THE PUPIL IS NORMALLY REACTING IN 3RD NERVE PALSY
Complete 3rd nerve palsy

16. Unilateral lid retraction Bilateral lid retraction
Thyroid eye disease
Unilateral lid retraction
Unilateral proptosis
Bilateral lid retraction
Bilateral proptosis
In 50% of cases

17. Thyroid eye disease 1. Soft tissue involvement 2. Eyelid retraction
Periorbital and lid swelling
Conjunctival hyperemia
Chemosis
Superior limbic keratoconjunctivitis
2. Eyelid retraction
3. Proptosis
4. Optic neuropathy
5. Restrictive myopathy

19. Lid lag on down gaze movement

20. Proptosis Occurs in about 50%
not influenced by treatment of hyperthyroidism
Axial and permanent in about 70%
May be associated with choroidal folds
Treatment options
Systemic steroids
Radiotherapy
Surgical decompression

21. keratoconjunctivitis
Soft tissue involvement
Periorbital and lid swelling
Conjunctival hyperaemia
Superior limbic
keratoconjunctivitis
Chemosis

22. Optic neuropathy Occurs in about 5% Early defective colour vision
Usually normal disc appearance
Caused by optic nerve compression at
orbital apex by enlarged recti muscles
Often occurs in absence of significant
proptosis

23. Restrictive myopathy Occurs in about 40% Due to fibrotic contracture
Elevation defect - most common
Abduction defect - less common
Depression defect -uncommon
Adduction defect - rare

24. Inflammatory conditions
(Sarcoidosis)
Idiopathic multisystem disorder
Characterised by non-caseating granuloma
More common in women yrs
More common in blacks and Asians
Eyes – 30%

25. Inflammatory conditions
(Sarcoidosis)
Anterior segment lesions (30%)
Conjunctival granuloma
Acute or chronic uveitis
Lacrimal gland involvement& dry eye
Posterior segment lesions (20%)
Patchy venous sheathing
Cellular infiltrate around vessels
Chorioretinal granulonmas
Vasculitis
Neovascularisation
Infiltrate in vitreous (vitritis)

26. Sickle cell retinopathy
Hyphema
New vessel formation
Sea fan neovascularization

27. White centered hemorrhage (Roth’s spot)
Leukemia
Sterile hypopyon
White centered hemorrhage (Roth’s spot)

28. Metastatic lung cancer
Metastasis
Metastatic lung cancer
Metastatic renal cell carcinoma
Metastatic lymphoma

29. Increase in size and number throughout
Neurofibromatosis type-1 (NF-1)
Café-au-lait spots
Most common phacomatosis
Affects 1:4000 individuals
Presents in childhood
Appear during first year of life
Increase in size and number throughout
childhood

30. Eyelid neurofibromas in NF-1
Nodular
Plexiform
May cause mechanical ptosis
May be associated with glaucoma

31. Intraocular lesions in NF-1
Lisch nodules
Congenital ectropion uveae
Very common - eventually present
in 95% of cases
Uncommon - may be associated
with glaucoma
Choroidal naevi
Retinal astrocytomas
Rare - identical to those seen in
tuberous sclerosis
Common - may be multifocal
and bilateral

32. Common - combined hamartomas of RPE
Ocular features of NF-2
Very common -
presenile cataract
Common - combined hamartomas of RPE
and retina

33. Peripheral corneal involvement in
Rheumatoid arthritis,Wegener granulomatosis, polyarteritis nodosa
Without inflammation
With inflammation
Chronic and asymptomatic
Circumferential thinning with intact
epithelium (‘contact lens cornea’)
Acute and painful
Circumferential ulceration and
infiltration
Treatment - systemic steroids and/or cytotoxic drugs

34. GIANT CELL ARTERITIS Systemic signs & symptoms Headache
Scalp tenderness
Thickened temporal arteries
Jaw claudication
Acute visual loss
Weight loss, anorexia, fever, night sweats, malaise & depression
Ocular Complications
Transient monocular visual loss (amaurosis fugax)
Visual loss due to
Central retinal artery occlusion (CRAO) or
Anterior ischaemic optic neuropathy (AION)
Visual field defects

35. Systemic infections Can affect any part of the eye Tuberculosis
Lids optic nerve.
Can be limited to the eye only Difficult Dx
Requires systemic antimicrobial therapy PLUS Steroids
Can cause severe visual loss secondary to inflammation and infection.
Tuberculosis
Syphilis
HIV
Toxoplasmosis
Brucellosis
Herpes zoster
Candida infection

36. Retinitis with vasculitis Endogenous endophthalmitis
Systemic infections
Retinitis with vasculitis
Endogenous endophthalmitis

37. Systemic infections
Anterior Uveitis
Herpes Zoster Ophthalmicus