Systemic disease and the eye for final MBBS
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Systemic disease and the eye for final MBBS

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Eye/ ophthalmology lectures for final MBBS by Dr.Saman Senanayake

Eye/ ophthalmology lectures for final MBBS by Dr.Saman Senanayake

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Systemic disease and the eye for final MBBS Systemic disease and the eye for final MBBS Document Transcript

  • Systemic Disease and the Eye 1. Systemic Disease 2. Endocrine 3. Neurology 4. Cardiovascular 5. Rheumatology 6. Dermatology 7. Genitourinary 8. Gastrointestinal 9. Respiratory 10. Nephrology 11. Treatment of systemic disease Endocrine 1. Diabetes mellitus  Major cause of blind and partial registration in people < 65 years in the western world 2. Thyroid        Eye and orbital changes usually in association with hyperthroidism - Graves’ disease Patient may be clinically and biochemically euthyroid - ophthalmic Graves’ disease Immunologically mediated disease Exophthalmos (proptosis) Grossly swollen extraocular muscles - esp. medial and inferior recti Lid retraction and lid lag Major complications include: o Optic nerve damage o Corneal perforation Neurology        Anything! As ophthalmology comprises the eye AND visual system Any lesion that interferes with the visual pathways III, IV, VI cranial nerve palsies Horner’s syndrome Demyelinating disease Myasthenia gravis Myotonic dystrophy 1
  • Cardiovascular       Hypertension Atherosclerosis Arteriosclerosis Hyperlipidaemia Embolic phenomena Retinal vascular occlusion o CRAO o BRAO o CRVO o BRVO  Anterior ischaemic optic neuropathy  Hypertensive retinopathy Rheumatology  Rheumatoid arthritis  Seronegative arthritides - HLA-B27 +ve o Ankylosing spondylitis, Reiter’s disease  Sjogren’s syndrome  Juvenile idiopathic arthritis  Behçet’s disease  Sarcoidosis  SLE  Wegener’s granulomatosis  Giant cell arteritis  Dry eyes o RA o Sjogren’s  (Epi)Scleritis o Mainly RA  Uveitis o Behçet o Sarcoidosis o JIA  Vascular occlusion o SLE  Orbital disease o Wegener’s  AION (CRAO) o GCA Behçet’s Disease  Idiopathic multisystem disorder  Occlusive vasculitis - eyes involved in 75% 2
  •  Presents in the 3rd and 4th decades  Diagnosis: Oral ulceration with two of o Recurrent genital ulceration o Skin lesions - folliculitis, erythema nodosum o Positive pathergy test o Eye involvement  Acute anterior uveitis  Vitritis, vasculitis, retinitis  Treatment: systemic immunosuppression Dermatology         Acne rosacea Topical allergy Stevens-Johnson syndrome (erythema multiforme) Psoriasis Herpes zoster ophthalmicus Mucous membrane pemphigoid Sturge-Weber Lid tumours o BCC, SCC Stevens Johnson Syndrome       Acute, self limiting, males > females Hypersensitivity reaction to drugs and infection resulting in an acute vasculitis Presentation: fever, malaise, sore throat, arthralgia Eye: pseudomembranous conjunctivitis, cicatrisation of the conjunctiva and lids Skin: symmetrical erythematous maculopapules, vesicubullous lesions Mouth: bullae, erosions, haemorrhagic crusts Cicatricial Mucous Membrane Pemphigoid  Rare, idiopathic, chronic progressive, females>males  Inflammation followed by scarring  Skin: 25% o Type I: recurrent vesicobullous, non-scarring o Type II: Localised erythematous plaques, with recurrent vesicles and bullae, healing to small atrophic scars  Mouth: 80% o Submucosal blisters leading to erosions, scars and strictures  Eye: 50-70% o Dry eye, symblepharon, ankyloblepharon, keratopathy 3
  • o Treatment with topical and systemic steroids, immunosuppressants, silicone contact lenses, lid surgery Genitourinary  Syphilis o Uveitis  Chlamydia (NSU) o Conjunctivitis  Gonorrhoea o Conjunctivitis  HIV o Opportunistic infection - esp. CMV Others  Gastrointestinal o Crohn’s o Ulcerative colitis  Respiratory o Sarcoidosis  Nephrology o SLE o Wegener’s Systemic Disease - Treatment  Corticosteroids o Posterior subcapsular cataract o Secondary glaucoma  (Hydroxy)Chloroquine o Maculopathy  Desferrioxamine o Maculopathy  Tamoxifen o Maculopathy  Quinine o Optic atrophy, arteriolar narrowing  Amiodarone o Corneal change  Vigabatrin o Visual field loss 4