The document summarizes various ocular manifestations of systemic diseases. It discusses how conditions like diabetes, hypertension, sarcoidosis, thyroid disease, and infections can present with issues like uveitis, cataracts, retinal vessel abnormalities, proptosis, ptosis, and abnormal eye movements. It provides details on characteristic signs, potential etiologies, and implications for underlying systemic illnesses for each type of ocular presentation.
3. The eyes are actually a part of the
human body sharing functions with
it , and affected by factors leading to
its deterioration …
It can be your mirror if you knew
how to use
4. Here are some of the main
complaints that are
commonly faced
9. Optic neuritis
• Rapidly developing impairment of vision in 1
eye or, less commonly, both eyes
• Dyschromatopsia ,may be more prominent than
the decreased vision
• Retro-orbital or ocular pain exacerbated by eye
movement
• Uhthoff phenomenon, in which vision loss is
exacerbated by heat or exercise
• Pulfrich phenomenon, in which objects moving
in a straight line appear to have a curved
trajectory: Presumably caused by asymmetrical
conduction between the optic nerves
10. Multiple sclerosis
is the most common
manifestation (usually unilateral,
but may be bilateral) and the
presenting feature in about 25% of
MS patients
About 60% of patients in the 20-
40 years age group who present
with ON will subsequently develop
evidence of systemic
demyelinisation !
13. Temporal arteritis
• is a systemic inflammatory vasculitis of
unknown etiology that affects medium-
and large-sized arteries.
The clinical criteria is :
1. New headache (localized temporal)
2. Abnormalities of the temporal arteries
(tenderness or decreased temporal artery
pulse)
3. (ESR) of 50 mm/h
4. Positive results of a temporal artery
biopsy
5. visual impairment may occur in as many
as 60% of patients
14. • The most common cause of
vision loss is anterior ischemic
optic neuropathy (AION). This
results from ischemia of the optic
nerve head
• optic neuropathy, central retinal
artery occlusion, branch retinal
artery occlusion
• diplopia, ptosis,nystagmus,
internuclear ophthalmoplegia
(INO),and pupillary
abnormalities. Branch retinal vein occlusion in a patient
with giant cell arteritis
17. Dermatochalsis
• Chronic dermatitis , as of the chronic
inflammation leads to recurrent edema and
redundancy of the eyelid skin.
• Thyroid eye disease frequently associated
with dermatochalsis and steatoblepharon
,infiltration of the orbital fat and extraocular
muscles with immunoglobulin complexes.
• Chronic renal insufficiency can be associated
with periorbital edema. When chronic
edema can result in stretching of the eyelid
skin and redundancy of the eyelid
20. Signs of eyelid retraction
Occurs in about 50%
Bilateral lid retraction
Bilateral proptosis Lid lag in downgaze
21. Proptosis
• Occurs in about 50%
• Uninfluenced by treatment of hyperthyroidism
Axial and permanent in about 70% May be associated with choroidal folds
22. • Occurs in about 40%
• Due to fibrotic contracture
Restrictive myopathy
Elevation defect - most common Abduction defect - less common
Depression defect - uncommon Adduction defect - rare
23. Ptosis
• Any condition causing the upper eyelid to swell may cause ptosis
• Reduced Sympathetic Activity (Horner’s syndrome )
• Partial Ptosis , Miosis , anhydrosis
Brainstem stroke or tumor , 33% of patients with brainstem lesions demonstrated
Horner syndrome
Tumors (eg, Pancoast) or infection of the lung apex
Dissecting carotid aneurysm
Demyelinating disease (eg, multiple sclerosis)
Central venous catheterization , Chest tubes
Lymphadenopathy (eg, Hodgkin disease, leukemia, tuberculosis, or mediastinal tumors)
Lesions of the middle ear (eg, acute otitis media
24. • Muscular , nerve , neuromuscular
junction : myotonic dystrophy ,
polymyositis, dermatomyositis , myasthenia,
Lambert–Eaton syndrome
• Oculomotor nerve palsy
giant cell arteritis, Infection, cavernous
sinus thrombosis ,
diabetes mellitus
Miller Fisher syndrome, associated with
antibodies to ganglioside GQ1b In Miller
Fisher syndrome, extraocular muscle
involvement is the rule but there are
reports of isolated ptosis.
29. • is a neurological
disorder characterized
by dilated pupil that reacts slowly
to light but shows a more definite
response to accommodation
• the classic signs of Argyll
Robertson pupil, are rigidity to
light and contraction to
accommodation
• it has been seen with herpes
zoster, sarcoid, von Beonomo's
encephalitis, diabetes, Lyme
disease, Wernicke's
encephalopathy.
• Tertiary syphilis
Holmes-Adie syndrome Argyl robertson pupil
36. Two types of cataracts result from diabetes
Earlier onset age-related
• diabetic cataract ,more common
type is which occurs in type I or II
diabetics.
• It is very similar to other age-
related cataracts, and may
present as a cortical, posterior
subcapsular
snowflake cataract
• Rare, bilateral, occurs rapidly, and
related to very high, uncontrolled
DM in young type II diabetics
48. Ocular involvement in Behçet disease
• Ocular involvement is seen in about 70% of patients
• In most cases, the ocular symptoms follow the oral
and genital ulcers by 3-4 years, although ocular
disease is the initial manifestation in about 20% of
cases.
• The classic finding of Behçet disease, iridocyclitis
with hypopyon, is present in about one third of
cases.
• Gonioscopy may reveal an occult hypopyon
characterised by hypopyon that it may change
position with head movement, and it may form
and disappear rapidly without sequelae.
• Recurrent attacks may result in posterior
synechiae, peripheral anterior synechiae, iris
atrophy, and secondary glaucoma.
A 19-year-old boy presenting with vitreous
haze, and retinal infiltrates due to Behçet’s
disease.
49. • The classic fundus finding is retinal vasculitis
• retinal hemorrhages, yellow-white exudates deep in the
retina, white focal retinal infiltrates, retinal edema, and
optic disc edema with hyperemia.
• Retinal neovascularization, secondary to either retinal
vein occlusion or chronic inflammation, may result in
retinal or vitreous hemorrhage.
• Neovascular glaucoma
• Vitreous cellular infiltration almost always is present
during the acute phase.
• Repeated episodes of posterior segment inflammation
cause sheathing of retinal vessels, chorioretinal scars, and
retinal and optic nerve atrophy.
52. SARCOIDOSIS
Ocular Involvement
• Conjunctival granuloma
• Lacrimal gland involvement/dry
eye
• Acute or chronic uveitis
• KPs described as ‘mutton fat’
because they are large and greasy
• Chorioretinal granulonmas
• Vasculitis including occlusive causing:-
• Neovascularisation
• Infiltrate in vitreous (vitritis)
• Optic nerve head granuloma
53.
54. The retina is affected by many diseases , but
thecommonest are diabetes , hypertension ,
57. Diabetic retinopathy
• Diabetic retinopathy is the leading cause of new blindness in persons aged
25-74 years in the United States . And classified as :
Background diabetic retinopathy
Nonproliferative diabetic retinopathy
proliferative diabetic retinopathy
Maculopathy
68. ANTERIOR SEGMENT COMPLICATIONS OF
DIABETES
Recurrent, non-healing corneal
epithelial defects
Neovascular glaucoma
Diabetes lowers the resistance of the
patient to pyogenic infections and
predisposes to recurrent styes
69. Transient Refractive Changes and diabetes
Accommodation Disorders.
Weakness of accommodation may result when the ciliary muscle
becomes weakened by peripheral neuritis involving its nerve supply.
Subjective Visual Disturbances.
Amaurosis may occur in severe cases of diabetes. Disturbances of the
visual cortex may lead to misty vision and to lashes of light which patients
may experience after an overdose of insulin. .