This document summarizes various eye findings and their association with systemic diseases. It outlines signs and symptoms involving the eyebrows, eyelids, eyeballs, conjunctiva, sclera, cornea, iris, pupils, lens, and retina that may indicate underlying conditions like hypothyroidism, sarcoidosis, diabetes, or vascular diseases. Specific findings discussed include ptosis, exophthalmos, arcus senilis, Roth's spots, microaneurysms, and signs of hypertensive and diabetic retinopathy. The document provides differential diagnoses for many of the eye signs and emphasizes that eye exams can help detect systemic illnesses.

1. Short topic
•Eye an indicator of
systemic diseases
Chair person-Dr.chandrashekar K
Student-Dr.Nagaraj T

3. Eye Findings and Systemic Diseases

4. Systemic ds with ocular involvement

7. Normal fundus

8. Eyebrows and eye lashes

9. D/D
• Hypothyroidism
• Secondary syphilis
• Leprosy
• Generalized alopecia

11. D/D
• Vogt-Koyanagi-Harada disease
• Waardenburg syndrome
• Vitiligo
• Albinism

12. Lacrimal gland
• Sarcoidosis
• Sjogren’s syndrome
• Mikulicz syndrome

13. Eyelids
• PTOSIS
• This is drooping of the upper lid to a level that
covers >2 mm of the superior cornea.

14. Causes
• 1. Congenital
• (i) simple
• (ii) complicated
• 2. Acquired
• (i) neurogenic
• (ii) myogenic
• (iii) aponeurotic
• (iv) mechanical

15. Neurogenic ptosis
• 3rd nerve palsy
• Horner’s syndrome
• Multiple sclerosis

16. Myogenic/N-M junction
• Myasthenia gravis
• Snake bite
• Myotonic dystrophy
• Eaton lambert myasthenic syndrome
• Oculo-pharyngial muscular dystrophy

18. • Dalrymple sign is lid retraction in primary gaze
• Kocher sign describes a staring and frightened
appearance of the eyes which is particularly
marked on attentive fixation
• Von Graefe sign signifies retarded descent of
the upper lid on down gaze

19. Eyeballs
Proptosis /Exophtholmos
• Pulsating
• Intermittent-orbital varix
Enophtholmos
Nystagmus

20. Proptosis

21. DD

22. Conjunctiva
• Pallor
• Cyanosis
• Phlyctenular keratoconjunctivitis
• Bitot’s spots

23. Bitot’s spots

24. Sclera
• Icterus
• Scleritis /Episcleritis
• Blue sclera

25. Cornea
• Corneal Arcus
• KF ring
• Keratoconjunctivitis sicca

26. Arcus senilis

27. KF ring

28. DD
• Wilson’s disease
• Cholestasis
• Primary biliary cirrhosis
• Cryptogenic cirrhosis

29. Iris/uvea
• Heterochromia of iris
• Rubeosis iridis
• Uveitis

31. Heterochromia of Iris
• In this condition, one iris is a different colour
from the other.
• Waardenburg's syndrome
• Hirschsprung's disease

32. New vessels on iris

33. DD of Rubeosis Iridis
• Diabetic retinopathy
• Sickle cell retinopathy
• CRVO
• Retinoblastoma
• Ocular ischemic syndrome

34. Scleritis/episcleritis/Uveitis
• Rheumatoid arthritis
• SLE
• Behçet's disease
• Ankylosing spondylitis
• Crohn's disease.
• Ulcerative colitis.
• Sarcoidosis

35. Examination of Pupils
• Number(polycoria)
• Location(corectopia)
• Size –Miosis/Mydriasis
• Color
• Pupillary reactions

36. Miosis
• Iridocyclitis
• Bright light
• Horner’s syndrome
• Parasympathomimetic drugs
• Pontine bleed
• Opiates
• Argyll Robertson pupils
• Ethanol/Barbiturate poisoning

37. Mydriasis
• Dim illumination
• 3rd nerve palsy
• Internal ophthalmoplegia
• Sympathomimetic/parasympatholytic drugs
• Belladonna poisoning
• Acute congestive gluacoma

38. Pupillary reactions
 Direct light reflex
 Consensual light reflex
 Swinging flash light test
 Accommodation reflex

39. Abnormal pupillary reactions
• 3rd nerve palsy
• Horner’s syndrome
• Holmes-Adie pupil
• Argyll-Robertson pupils
• Marcus gunn pupil

40. Lens
• Subluxation/Dislocations
• Cataract

41. Marfan’s syndrome

42. Homocystinuria

43. Cataract
• Most cataracts are age-related
• Underlying systemic diseases will result in presenile
cataract formation-
Metabolic abnormalities:
• Poorly controlled diabetes.
• Phosphofructokinase deficiency.
• G6PD deficiency.
• Hyperuricaemia

44.  systemic disease:
• Muscular dystrophy.
• Atopic dermatitis.
• Neurofibromatosis
• Congenital rubella
• Hypoparathyroidism.

45. Drug exposure:
• Steroids
• Chlorpromazine.
• Busulfan.
• Amiodarone.
• Gold.
• Allopurinol.

46. Examination of Retina

49. Roth’s spots
• Composed of Coagulated fibrin,platelets,focal
ischemia,inflammatory infiltrate,infectious
organisms or neoplastic cells
• Infective endocarditis
• SLE
• HIV retinopathy
• Leukemia

51. Diffuse flame shaped hemorrhage

52. D/D
• Hypertension
• Anemia
• Leukemia
• Thrombocytopenia
• CRVO

55. Central retinal artery occlusion
• CRAO should prompt a search for a source of
atherosclerosis, emboli or
• Inflammatory causes - giant cell arteritis,
granulomatosis with polyangitis, SLE.
• Carotid artery stenosis.
• Protein S, protein C deficiency and antithrombin
deficiency
• Antipospholipid syndrome, leukaemia and
lymphoma.

56. Dilated tortous veins and extensive
hemorrhage in CRVO

57. Central Retinal vein occlusion
• Hypertension
• Diabetes
• Smoking
• Hyperlipidemia
• Hyperviscocity states
• Thrombophilia
• Vasculitis

58. Hypertensive retinopathy grade4

59. Micro aneurysm

61. • Diabetic retinopathy
• Eales disease
• CRVO/BRVO
• Sickle cell anemia
• ROP

64. Ocular manifestations of Diabetes
• Lids-xanthelasma,recurrent stye
• Cornea- decreased sensation,corneal ulcers
• Iris – rubeosis iridis
• Lens-cataract
• Vitreous-hemorrhage
• Retina-diabetic retinopathy
• IOP-POAG,neovascular glaucoma
• Optic neuritis,ophthalmoplegia

65. Diabetic retinopathy

67. Thyroid eye disease
• The five main clinical manifestations of TED
are
• (a) soft tissue involvement,
• (b) lid retraction
• (c) proptosis
• (d) optic neuropathy and
• (e) restrictive myopathy

68. Reference
• Parson’s diseases of the eye-22nd edition
• Jack J Kanski clinical ophthalmology-7th edition
• Review article-Ophthalmic features of systemic
diseases 2012
• A K Khurana text book of ophthalmology 5th edition

69. THANK YOU