OCULAR MANIFESTATIONS OF SYSTEMIC DISEASES The eye is intimately linked not only with the adjacent structures but also with the remote organs of the body. Ocular manifestations are so common in many systemic diseases that the ophthalmoscope is an

1
OCULAR MANIFESTATIONS OF SYSTEMIC DISEASESThe
eye is intimately linked not only with the
adjacent structures but also with the remote
organs of the body. Ocular manifestations are so
common in many systemic diseases that the
ophthalmoscope is an essential part of the of
every competent physician. No medical examination
is really thorough or complete without
examination of the fundus.
2
METABOLIC DISORDERSDIABETES MELLITUS Ocular
complications are common in diabetes, but bear
little relation to the severity of the disease.
They depend much more on the duration of the
diabetes and commonly occur in long-standing
cases. Lesions of the lids.Diabetes lowers the
resistance of the patient to pyogenic infections
and predisposes to recurrent styes.Lesions of
the Conjunctiva and the Cornea.Conjunctivitis
and keratitis are possible complications.Lesions
of the Iris.The iris may exhibit the following
lesions Rubeosis lridis Edema and Vesiculation
of the Pigment Epithelium. This leads to easy
scattering of the iris pigment by mild trauma.
3
Transient Visual Disturbances Transient
Refractive Changes. Accommodation
Disorders.Weakness of accommodation may result
when the ciliary muscle becomes weakened by
peripheral neuritis involving its nerve
supply.Subjective Visual Disturbances.
Amaurosis may occur in severe cases of diabetes.
Disturbances of the visual cortex may lead to
misty vision and to lashes of light which
patients may experience after an overdose of
insulin. .
4
Diabetic Cataract. Diabetic Retinopathy.
Intra-Ocular Haemorrhage. This is due to rubeosis
iridis. Retrobulbar Optic Neuritis.Diabetic
optic neuritis is usually bilateral, rapid in
onset and often painless. Ocular
Tension.Hypotony may occur in cases of diabetic
coma. Extra-Ocular Muscle Palsies.Paralysis of
one or more of the extrinsic ocular muscles may
occur.
5
DISTURBANCES OF CALCIUM METABOLISMHypocalcemia
Cataract. Myopia. VITAMIN DEFICIENCIESVITAMIN
A DEFICIENCYThe chief ocular manifestations of
Vitamin A deficiency are defective night-vision
and xerophthalmia. Blepharitis, recurrent
chalaiza and styes, chronic conjunctivitis and
keratomalatia are also commonVITAMIN B
DEFICIENCY Vitamin B1 Deficiency
Conjunctivitis. Nystagmus. Papilloedema.
Retinal haemorrhages. Extra-ocular muscle
paralysis.
6
Vitamin B2 (Riboflavine) Deficiency
Photophobia together with itching and burning
sensations.Conjunctivitis is a typical
manifestation.Peripheral vascularization of the
cornea is often present.Cataract can be produced
experimentally in riboflavin deficiency.Fundus
changes consist of hyperaemia of the disc,
papilloedema, VITAMIN C DEFICIENCYOrbital
haemorrhage. Conjunctival and palpebral
haemorrhages. Keratoconjunctivitis. Cataract.
Retinal hemorrhages. VITAMIN D
DEFICIENCYLamellar cataract.High myopia, spring
catarrh, phlyctenular keratoconjunctivitis and
conical cornea
7
DISEASES OF THE ENDOCRINE GLANDPITUITARY
GLANDHeadache It is often bitemporal and of a
"bursting" type. Visual Field Defects. The loss
of fields to colours is always more extensive
than to white.Typically, the field defect
commences in the periphery of the upper temporal
quadrant and extends downwards to produce the
typical bitemporal hemianopia.Optic Atrophy but
occasionally papilladema.Ocular Palsy due to the
pressure effects by a laterally growing tumour on
the oculomotor, trochlear or abducent
nerves.Slight Exophthalmos may occur as a result
of a disturbed production of thyrotropic hormone.
8
PINEAL GLAND Severe headache and papilloedema
are early manifestations, caused by the blockage
of cerebro-spinal fluid circulation at the
aqueduct of SylvianOcular palsies and ptosis
often occur.Failure of the pupillary light
response may develop as a result of pressure on
the pathway of the pupillarlight reflex.
9
THYROID GLAND Manifestations of Thyroid
Hypofunction (Myxoedema)Puffiness of the
eyelids.Loss of hairs of the outer half of the
eyebrows. Bilateral Manifestations of Thyroid
Hyperfunction (thyrotoxicosis retrobulbar
neuritis and optic atrophy may occur.Exophthalmos
which may lead to exposure keratitis.Lid
retraction and lid lag of the upper eyelid.Odema
of the eyelids.Pigmentation of the
eyelids.Congestion of the conjunctiva
vessels.Ocular palsies, especially affecting the
superior rectus muscles leading to
diplopia.Convergence insufficiency.Fundus
changes include visible arterial pulsation,
papilloedcma, partial optic atrophy, exudates in
the posterior pole and degeneration of the
macula.Rarely, retrobulbar neuritis.
10
DISEASES OF THE KIDNEYSRenal Retinopathy The
retinopathy occurs typically in type II nephritis
and sometimes after type 1 nephritis.
Ophthalmoscopic Signs of Renal (Hypertensive)
RetinopathyConstriction of the Retinal
Arteriols. Generalized Retinal Edema with Edema
of the Optic Disc. Numerous Cotton-Wool
Patches. Retinal Haemorrhages. Hard White
Exudates Exudative Retinal Detachment.
Crystalline Retinal Deposits
11
TEMPORAL ARTERITIS.Ocular manifestations are
present in about 50 of cases. The eye signs
include temporary incomplete external
ophthalmoplegia, serve optic neuritis and
unilateral, but sometimes bilateral, occlusion of
the central retinal artery leading to complete
blindness. PERIARTERTTIS NODOSAPeriarteritis
nodosa is an inflammatory disease of the coats of
the small and medium-sized arteries of the body
with inflammatory changes around the vessels.
Ocular manifestations include angiospastic
retinopathy, central retinal artery occlusion,
iritis, keratitis, ring ulcer of the cornea,
scleritis and extra-ocular muscle palsy. Systemic
corticosteroids are of some values but the
prognosis is usually bad.
12
RHEUMATOID ARTHRITISThe ocular manifestations of
rheumatoid arthritis include commonly
iridocyclitis, but rarely scleromalcia
performs.Ankylosing spondylitis.The disease
affects the joints of the spine and is associated
with recurrent iridocyclitis. CHRONIC
GRANULOMATOUS DISEASESTUBERCULOSISConjunctivitis
. Phlyctenular keratoconjunctivitis.
Interstitial keratitis. Sclerosing keratitis.
Anterior uveitis. Nodules on the iris. Miliary
tuberculosis. Choroiditis (tuberculoma)
Perivasculitis retina(Eales' disease). Optic
neuritis.Dacryoadenitis. Dacryocystitis.
13
SYPHILIS Chancre of the lid. Gumma of the
tarsal plate. Gumma of the lacrimal gland.
Chancre of the conjunctiva. Interstitial
keratitis. Iridocyditis. Congenital
(lamellar) cataract. Choroido-retinitis. Optic
neuritis. Primary optic atrophy. Paralysis of
the extrinsic ocular muscles. LEPROSYNodules on
eyelids or anesthetic patches.Nodules on the
conjunctiva or sclera.Interstitial keratitis,
Superficial punctate keratitis, Leprotic
pannus.Iritis, Secondary glaucoma
14
SARCOIDOSISSarcoid nodules on the
eyelids.Painless nodular enlargement of the
lacrimal glands which may be unilateral or
bilateral. Episcleral nodules.Nodular
iritis.Nodular choroido-retinitis.
15
DISEASES OF THE MUSCLESMYASTHENIA
GRAVISMyasthenia gravis is a chronic
neuromuscular disease characterised by fatigue
and exhaustion of the muscular system marked by
progressive paralysis of muscles without sensory
disturbance or motor nerve paralysis, The
disease is presumably due to a curare-like block,
interfering with the normal action of
acetylcholine at the myoneural junction. the
disease generally commences the levator palpebrae
superioris muscle leading to ptosis. Later, the
disease involves the extra-ocular muscles,
Diplopia.Convergence insufficiency. Weakness
of accommodation.
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
ReferencesParsons diseases of the eye