Lecture 6 THE CHANGES OF VISUAL ORGAN IN SYSTEMIC DISEASES

1
Lecture
6THE CHANGES OF VISUAL ORGAN IN SYSTEMIC
DISEASES
Lecture is delivered by Ph. D., assistant of
professor Tabalyuk T.A.
2

• FUNDUS CHANGES IN ARTERY HYPERTENSION
• (Krasnov M., 1948)
• Hypertensive angiopathy mild generalized
  arteriolar narrowing, tortuosity and dilation of
  veins, Gvists symptom (tortuosity of small
  venuls around macula).
• Hypertensive angiosclerosis thickening of
  arteriolar walls, cooper wiring, silver
  wiring, symptom of arteriovenous crossing
• Salus-Gun-Relman I - conic narrowing of vein in
  arteriovenous crossing
• Salus-Gun-Relman II - arc bending of vein in
  arteriovenous crossing
• Salus-Gun-Relman III - absence of vein picture in
  arteriovenous crossing.
• Hypertensive retinopathy all above changes plus
  retinal haemorrhages, cotton wool spots and hard
  exudates.
• Hypertensive neuroretinopathy all above changes
  plus optic disc swelling.
• Management
• control of blood pressure and treatment by
  general practitioner
• regular review if treatment is not indicated
• vitaminotherapy, tissue therapy and proteolitic
  ferments to dissolve retinal haemorrhages and
  exudates.

3
Salus-Gun-Relman I
4
Salus-Gun-Relman III
5
(No Transcript)
6
Hypertensive retinopathy(Kanski Jack)

• Grade 1 mild generalized arteriolar narrowing
• Grade 2 focal as well as marked generalized
  arteriolar constriction
• Grade 3 as Grade 2 plus retinal haemorrhages,
  cotton wool spots and hard exudates
• Grade 4 as Grade 3 plus optic disc swelling

7
Retinal artery occlusion (RAO)

• Aetiology embolization from a carotid or cardiac
  source, or vazoobliteration by atheroma or
  arteritis.
• Clinical features acute loss of vision may be
  permanent or transient (amaurosis fugax). Retinal
  pallor corresponding to the involved area
  (central or branch) is seen, and in central RAO a
  cherry red spot at the fovea is typically
  present. Segmentation of the arteriolar blood
  column (cattle trucking) may be seen. Later the
  arterioles become attenuated and the optic disc
  pale.
• Emmergency s/l nitroglicerini, validoli,
  euphyllini i/v, no-spa or acidi nicotinici i/m,
  diacarbi per os.
• Acute RAO may be relieved by lowering IOP by
  nassage, intravenous acetaxolamide, anterior
  chamber paracentesis

8
Central retinal artery occlusion with cherry-red
spot
9
Retinal vein occlusion (RVO)

• Predisposing factors include increasing age,
  hypertension, hyperviscosity, trombophilic
  disorders, and raised IOP.
• Presents with sudden mild to severe loss of
  vision in one eye. Acute signs include
  haemorrhages, cotton wool spots, venous
  tortuosity, optic dics and retinal oedema. Fundus
  picture in RVO is called picture of pressed
  tomato or red ischaemia.
• Classification
• Branch RVO usually involves a retinal quatrant
• Hemiretinal veib occlusion
• Central RVO (ischaemic or non-ischaemic).
• Emmergency anticoagulants (heparini),
  trombolytics (streptodekesa), and antiagregants
  (pentoxiphillini) systemically.

10
Central retinal vein occlusion
11
Branch retinal vein occlusion
12
Peculiarities of renal hypertension exudative
syndrome, retinal oedema, a lot of cotton wool
spots on gray background, optic disc swelling,
star figure in macula. Peculiarities of
atherosclerosis - exudative syndrome is not
typical, the primary are thickening of arteriolar
walls, cooper wiring silver wiring. Fundus
picture in pregnancy toxicosis is like changes in
hypertensive angiopathy, retinopathy,
neuroretinopathy (arteriolar narrowing, its
tortuosity, haemorrhages, cotton wool spots,
optic disc swelling, star figure in macula).
Despite artery hypertension in arteriolar spasm
caused by pregnancy toxicosis, symptoms of
arteriovenous crossing are not marked. In severe
retinal swelling on background of pregnancy
toxicosis transsudative retinal detachment or
retinal vein occlusion may happen.
13
Retinopathy in renal hypertension.A color fundus
photograph that shows optic disk swelling,
cotton-wool spots (blue arrow), hemorrhages
(white arrow), retinal exudation and a macular
star (green arrow).
14

Diabetic retinopathy (DR) is the most common
cause of blidness in the working-age population.
The incidence of severity of DR are strongly
related to duration of diabetes good control of
blood glucose and hypertension are very
important. Fundus picture in
diabetic angiopathy - tortuosity and dilation of
veins, microaneurysms nonproliferative DR dot
and blot haemorrhages and hard exudates in
retina proliferative DR new vessel formation
at the optic disk or elsewhere on the retina.
Severe visual loss may occur as a result of
vitreous haemorrhage or tractional retinal
detachment due to constriction of fibrovascular
tissue. diabetic maculopathy is the most common
cause of visual impairment in patients with
diabetes. Loss of visual functions is usually
caused by oedema, typically accompanied by
exudates. Less commonly, the macula becomes
ischemic, often with severe deterioration in
central vision.
15
(No Transcript)
16
(No Transcript)
17
Nonproliferative diabetic retinopathy
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23

24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
Management of DR Regular review if treatment
is not indicated, frequency dependent on
severity of DR Panretinal laser
photocoagulation for proliferative DR Grid or
focal laser photocoagulation for macular oedema
fitting certain criteria (clinically significant
macular oedema) Vitrectomy for persistant
vitreous haemorrhage or tractional retinal
detachment involving the centre of the macula.
.



34
Fundus photo showing scatter laser surgery for
diabetic retinopathy.
35

• The complex of hyperthyroidism (Graves disease)
  consists of the following eye signs
• Proptosis due to abnormal fluid infiltration of
  orbital contents
• Retraction of the upper lid due to overaction of
  the levator muscle (Dalrimples symptom)
• Diplopia due to malfunction of the extrinsic
  ocular muscle
• Visual loss due to the effects of corneal
  exposure or of pressure on the optic nerve
• Infrequent blinking (Shtelfags sign)
• Convergence weakness (Mebius sign)
• Hyperpigmentation of upper eyelid (Ellineks
  sign)
• Graefes sign is lid lag failure to follow the
  eyeball on down gaze
• Joffrois sign is excessive retraction of the
  upper lid on looking upwards.

36
Thyroid orbitopathy
37
The ear diseases, i.e. purulent processes in it
may be a source of purulent methastasis into the
orbit and eyeball. As a result orbital
cellulitis, choroiditis, panuveitis,
panophthalmitis, optic neuritis may occur. The
nose diseases may cause conjunctivitis,
blepharitis, chronic dacriocyctitis. The
stomatological diseases may result in orbital
periostitis or cellulitis, keratitis or
iridocyclitis. The brain tumours are assosiated
with papilloedema, hemianopsia, paralysis of
oculomotor muscles, visual disturbances of
cortical genesis. In rheumatoid diseases usually
uvea is involved. Iridocyclitis, choroiditis or
panuveitis may occur.
38
Orbital cellulitis

• Signs
• eyelids oedema
• chemosis
• proptosis
• limiting of eye movements
• decreasing of visual acuity
• general intoxication (headacke, increased
  temperature, brain signs).
• Optic neuritis, papilloedema, central vein
  occlusion may occur with outcome in optic
  atrophy.

39
OPTIC NEURITIS inflammation of the optic nerve,
with a range of causes, the most important being
multiple sclerosis. Clinical features
presents with subacute, usually unilateral,
impairment of central vision that may be
associated with pain, especially on eye movement.
The optic disc is usually normal (retrobulbar
neuritis) and occasionally swollen and red
(papillitis). Severe or recurrent attacks may
lead to optic atrophy. PAPILLOEDEMA disc
swelling caused by raised intracranial pressure.
Clinical features symptoms of raised
intracranial pressure including headaches and
nausea. Transient visual obscuration lasting a
few seconds are common but visual acuity is
normal until late. Signs early hyperaemia
with indistinct margins
established obvious elevation, peripapillary
haemorrhages and cotton wool spots
long-standing markedly elevated champagne
cork appearance
40
Optic neuritis
41
Papilloedema
42
(No Transcript)
43
THANK YOU FOR ATTENTION !