Eye manifestations of systemic diseases
The eye is a unique organ
In Development In Position In Structure
Systemic diseases affect eyes in various ways BUT ALSO Many of the systemic diseases may be first diagnosed by ophthalmologist
Thyroid gland Pituitary gland Anemia leukemia Astherosclerosis Hypertension
Cardiovascular & blood disorders
orta t relations are:
Collagen vascular diseases
Congenital Acquired: Rheu atoid arthritis Migraine. Pa illoede a. O tic neuritis. Pseudotu our cerebri. hakomatosis Vitamin A, B, C, D HIV
Eye manifestations of diabetes
Recurrent styes Xanthelasmas
Conjunctiva & Cornea
Conjunctivitis Cornea: recurrent erosions, ulcers..
Rubiosis irides Edema & vesiculation of pigment epithelium: easy scattering of iris pigment by mild trauma.
Senile catarct in diabetic patient, density accelerates more. True diabetic cataract
Develops quickly & rapidly progressive. Starts flocculent, snow flake, milky white cortical opacities.
Intraocular hgeHyphema Vitreous hge Retinal hge
Milky retinal vessels. vessels.
(diabetic optic neuropathy)Usually bilateral Rapid onset Often painless. painless.
Extraocular muscle palsy:
Diabetic third nerve palsy: palsy:
most common cause of isolated 3rd n. palsy..micro infarctions
Sixth nerve palsy
Transient refractive changes: Changes in the state of lens hydration & alteration of the refractive index of the lens due to osmotic changes. Hypermetropia: in hypoglycemia Hypermetropia: Myopia: hyperglycemia. hyperglycemia.
NO GLASSES PRESCRIPTION IN UNCONTROLLED DM
Weakness of accomodation due to weak ciliary muscles due to peripheral neuritis involving its nerve supply. supply.
Subjective visual disturbances:
Amaurosis in severe cases Flshes due to visual cortex disturbances in insulin overdose.
Causes of Visual Loss & Blindness in DRVitreous Haemorrhage from PDR Tractional Retinal Detachment involving the macula Maculopathy, Maculopathy, exudative and ischaemic Neovascular Glaucoma In addition: higher cataract prevalence
GoutCharecterized by excess of uric acid in blood, urate deposits of cartilages of small joints. Starts in big toe,,,then polyarticular.
Conjunctivitis Marginal corneal ulcer Episcleritis Tenonitis Iridocyclitis
Vitamin A deficiency
Night blindness: defective or degenerative night vision. Dry eye (Xerophthalmia) Bitot Bitots spots Corneal thinning keratomalaciaBlepharitis Recurrent styes & chalazia.
Vitamin A deficiency
Vitamin B deficiency
Vitamin B1 B1
Vitamin B1 B1
Vitamin B1 deficiency(Thiamine deficiency: Beri Beri: eri: (cardiac, (cardiac, muscular weakness, neuritis) neuritis)
Conjunctivitis Nystagmus Papilloedema Retinal hge Extra ocular muscle paralysis
Vitamin B2 (Riboflavin)
Vitamin B2 deficiency Riboflavin deficiencyConjunctivitis: Conjunctivitis: typical manifestation Peripheral corneal vascularization Cataract Fundus changes: changes:
Papilledema. Papilledema. Pigmentary changes of macula. Partial optic atrophy.
Vitamin C deficiency
Vitamin C deficiencyEye Manifestations
HemorrhageSubconjunctival Palpebral Orbital Retinal
Vitamin D deficiencyDaily therapeutic dose 2500 IU
Lamellar cataract AssociationsHigh myopia Phlyctenular conjunctivitis keratoconus
Thyroid Eye DiseasePatient may be: Hyper thyroid, euthyroid, Hypothyroid
Soft tissue involvement1. 2. 3.
Periorbital and lid swelling Conjunctival hyperaemia Conjunctival chemosis. chemosis.
2. 3. 4. 5.
Eye lid retraction Proptosis Optic neuropathy Restrictive myopathy
Soft tissue involvementPeriorbital and lid swelling Conjunctival hyperaemia
Superior limbic keratoconjunctivitis
Eyelid RetractionOccurs in about 50%
Bilateral lid retraction No associated proptosis
Bilateral lid retraction Bilateral proptosis
Unilateral lid retraction Unilateral proptosis
Lid lag in downgaze
ProptosisOccurs in about 50% TED is the commonest cause of proptosis (unilateral or bilateral) in adults
Axial and permanent in about 70%
May be associated with choroidal folds
Optic NeuropathyOccurs in about 5% Early defective colour vision Usually normal disc appearance
Caused by optic nerve compression at orbital apex by enlarged recti
Often occurs in absence of significant proptosis
Restrictive MyopathyOccurs in about 40% Due to fibrotic contracture
Elevation defect - most common
Abduction defect - less common
Depression defect - uncommon
Adduction defect - rare
Puffiness of eyelids. Loss of hair from outer third of the eye brow. Madarosis. Madarosis. Discrete spots in the central cornea. Whitish opacities of the lens periphery. Bilateral retrobulabar neuritis. Optic atrophy.
HypoparathyroidismPhotophobia Cortical lens opacity Lid twitches. Conjunctivitis & keratitis
Calcium crystal deposition in the conjunctiva Band shaped keratopathy. keratopathy.
Subconjunctival hemorrhages. Dilated tortous retinal veins. Edema, exudates. dema, Optic neuritis
Orbital infiltration Proptosis. Exophthalmos. Iritis with hypopion Spontaneous hyphema & subconj. hge.
Retinal edema, hemorrhages, tortous vessels, Roths spots. Roth Papillitis. Papillitis.
Grading of arteriolosclerosis
Arcus senilis Lipid keratopathy Arteriolar narrowing, focal or diffuse Arteriolar colour changes AV crossing changes, e.g. nicking flame hges, vessel sclerosis, threading
Hypertensive retinopathyArteriolar constriction
Generalized Extravascular signs
Arteriolosclerosis (A-V changes)
Flame-shaped retinal haemorrhages
Cotton-wool spots and macular star
Ocular associations of hypertension
Retinal vein occlusion
Retinal artery macroaneurysm
Anterior ischaemic optic neuropathy
Ocular motor nerve palsies
Connective Tissue Disorders
Connective tissue disorders
Marfans syndrome: Ectopia lentis, lentis, 2ry glaucoma, retinal detachment. EhlersEhlers-Danlos syndrome: Blue sclera, keratoconus, keratoconus, ectopia lentis, angioid streaks lentis,
Marfans syndromeEctopia lentis, lentis, 2ry glaucoma, retinal detachment.
Blue sclera keratoconus, keratoconus, ectopia lentis, lentis, angioid streaks
Acquired connective tissue disorders: Rheumatoid arthritis
Peripheral corneal thinning (CL Cornea). Iritis & its complications episcleritis Scleritis Scleromalacia perforans
Phlycten Uveitis Choroidal deposits
Interstitial keratitis Uveitis Chorioretinopathy BSK
Microphthalmia Cataract Glaucoma Uveitis Salt & pepper retinopathy
Viral infections: VaricellaVaricellaZoster
Parasitic: Toxoplasmosis Granulomatous: Sarcoid Fungal
Ocular regions related to systemic diseases
The corneal epithelium is of ectodermal embryologic origin
so it is affected by diseases of the skin and mucous membranes.
The rest of the cornea is of mesodermal embryologic origin:
so it is affected by disorders of collagen metabolism
Much of the cornea is made of collagen and mucopolysaccharide ground substance,
so systemic diseases affecting collagen may indirectly affect the cornea by way of auto antibodies in the circulation leading to limbal and marginal ulcerations.
The cornea stores materials made in excess by the body, so damage to the cornea may occur indirectly by accumulation of metabolic products. Systemic metabolic diseases that produce elevated levels of certain precursors and that may opacify the cornea. The cornea is the most anterior part of the eye, exposed to environmental harm.
Lens fibers opacify as a response to alterations of the physical and chemical medium within the semipermeable lens capsule.Chromosomal disorders Diseases of skin & mucous membrane Metabolic disorders & infections Toxic substances produced systemically
Secondary glaucomas may ariseas complications of the systemic disease itself or from its therapy.
UveitisInlftammation of the iris