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1. Cardiovascular disease :
ocular manifestations
Ms. M Khan

2. Cardiovascular Disease
• Cardiovascular disease affects not only the major arteries in the
systemic circulation-retinal vascular disease can be a
manifestation of generalized atherosclerosis or a result of
embolic disease originating from the cardiovascular system.
• Central retinal artery occlusion (CRAO) may occur secondary to
emboli from the carotid artery, or from the heart.
• Hypertension is a major risk factor for central retinal vein
occlusion.
• Atherosclerosis, hypertension and diabetes are all thought to be
possible risk factors for non-arteritic ischaemic optic neuropathy
(sudden, painless visual loss not associated with temporal
arteritis).

3. CVD
• Chronic • Hypertension
• Acute
• Non-arteritic ischemic optic neuropathy (NAION) ( disk at risk )
• Arteritic ischemic optic neuropathy (AION) ( proper Infarction )

4. The Heart
• Equivalent to the size of a clenched fist
• It is a cone-shaped, muscular organ
• It is in the thorax between the lungs, anterior to the backbone and
posterior to the sternum
• The apex is tilted to the left, and about two-thirds of the heart is
located to the left of the body's midline

5. The Blood Vessels
• Arteries: They are blood vessels that carry blood away from the heart.
• Capillaries: They are very thin and allow the exchange of oxygen-rich
blood and wastes in body cells so nutrients and oxygen can pass
through to organs, and waste products can be passed back
• Veins: Blood flowing out of capillaries is returned to the heart via the
veins.

6. HpT Retinopathy : Background
• Arteriosclerotic changes are caused by chronically elevated blood pressure
(>140/90) mmHg.
• In the vasoconstrictive phase, due to the elevated luminal pressures, local
autoregulatory mechanisms cause retinal arteriole narrowing and vasospasm
to reduce flow.
• In the sclerotic phase, the layers of the endothelial wall undergo changes such
as intimal thickening, medial hyperplasia, and hyaline degradation in the
arteriolar worsening arteriolar narrowing, AV crossing changes, and silver and
copper wiring .
• In the exudative phase, there is a disruption of the blood-brain barrier and
leakage of plasma and blood causing retinal hemorrhages, hard exudates,
retinal ischemia, and necrosis of smooth muscle.

7. Terminologies
• Retinal haemorrhages - develop when necrotic vessels bleed into
either the superficial retina (nerve fibre layer) (flame shaped
haemorrhage) or the inner retina (dot blot haemorrhage)
• Cotton wool spots - ischemia to the nerve fiber layer
• Exudates - result of lipid accumulation
• Papilledema - leakage and ischemia of arterioles supplying the optic
disc

8. Stages of Blood Pressure

10. Section
through
the
Retina

11. Stages of HpT Retinopathy

12. Stages of HpT Retinopathy

13. Retinal Emboli
• Platelet-fibrin
Dull, grey-white
Mobile
• Cholesterol
Bright, yellow-white, reflective
Mobile
• Calcific
Large, white
Stationary

16. Risk Factor ; Retinal Emboli
• Risk factors
• Hypertension
• Hyperlipidemia
• Increased white blood cell count
• History of past and current smoking
• Angina
• Coronary artery bypass surgery

17. • Branch retinal artery occlusion (BRAO)
• Central retinal artery occlusion (CRAO)
• Ophthalmic artery occlusion (OAO)

18. Retinal Emboli

19. HUMAN IMMUNODEFICIENCY VIRUS
• Retrovirus – replicates in CD4 T lymphocytes
• Multisystemic disease – Acquired immunodeficiency syndrome (AIDS)
• Transmission – blood and bodily fluid
Stages
• Primary infection
• Clinical latency
• Opportunistic infections (AIDS)
AIDS
• AIDS-defining disease
• CD4 T-cell count less than 200

20. Ocular Manifestation of Human
Immunodeficiency Disease
• Opportunistic infections
• Vascular abnormalities
• Neoplasms
• Neuro-ophthalmic
• Adverse effects of medication
Isolated in
• Tears
• Cornea
• Vitreous
• Chorioretinal tissue

21. Adnexa
• Herpes zoster Ophthalmicus (HZO)
• Kaposi sarcoma
• Molluscum contagiosum
• Conjunctival microvasculopathy

22. HERPES ZOSTER
OPHTHALMICUS
• Belongs to herpes virus family
• Double-stranded DNA virus
• Humans are the only natural host
• Primary infection: “chicken pox”
• Varicella zoster virus (VZV)

23. Kaposi Sarcoma
• Commonest type of cancer seen in
patients with HIV
• Highly vascularized, mesenchymal
tumour. Skin Lesions.
• Painless, violet coloured lesion
• Eyelid skin
• Conjunctiva

24. Molluscum
Contagiosum
• Dermatitis caused by a Pox virus.
• Characterized by multiple, small,
painless, umbilicated lesions on
the eyelid skin.

25. Anterior & Posterior Segments
• Patients could have the following Ocular Manifestations Anterior and
Posterior with Human Immunodeficiency Virus
• Keratoconjunctivitis sicca
• Keratitis
• Iridocyclitis
• Retinal microangiopathy
• Cytomegalovirus retinitis
• Progressive outer retinal necrosis
• Toxoplasmosis

26. Anteriorly
• HIV-mediated inflammatory destruction of lacrimal glands. Leads to KCS
• Rare cases of Keratitis. Usually, HSV or HZO but is recurrent if the patient
is not responding well to treatment.
• Iridocyclitis is seen in association with other conditions but its Less severe
than expected (weakened immune response).

27. Images…

28. RETINAL
MICROANGIOPATHY
• Most common
ophthalmic manifestation
• Cotton wool spots
• Retinal hemorrhages
• Microaneurysms

29. CMV RETINITIS
• Full thickness intraretinal
opacification
• Retinal hemorrhages
• Minimal Anterior Chamber
reaction
• No vitritis

30. PROGRESSIVE OUTER RETINAL NECROSIS
• VZV retinitis
• Retinal whitening and Hemorrhages
• Multifocal
• Rapid progression

31. Toxoplasmosis
• Acute
• Focal retinitis with overlying
vitreous inflammation
• “headlight in the fog”
• Chronic
• Pigmented Chorioretinal scar
• Bilateral and multifocal
• CNS involvement