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

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

4. Internal diseases eye AShypertensiondiabetes Vitamin deficiency Thyroid related eye diseases tuberculosisleukemiaretinopathy

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

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

7. 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%

8. Grade 1 Grade 2 Grade 4

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

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

11. 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

12. Nonproliferative diabetic retinopathy

13. Grade Ⅰ Grade Ⅱ Grade Ⅲ Nonproliferative DR Grading

14. Proliferative Diabetic retinopathy

15. Proliferative DR Grade Ⅳ Grade Ⅵ Grade Ⅴ

16. 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

17. 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

18. Tyroid related immune orbitopathy TAO Graves ophthalmopathy Immune disease

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

20. TRIO

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

22. 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 ）

23. Purtscher retinopathy

24. 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

25. 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

26. congenital Stromal keratitis chorioretinitis （ peppersalt fudus ） optic atrophy Syphilis

27. 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 0.5-1 mg neostigmine im 20-40yrs ， female

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

29. Pupillary edema

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