Tiffany Tran

ISM- Period 1

Lowth, Mary. "Eye in Systemic Disease." Patient. EMIS Group Plc., 22 Sept. 2015. Web. 28
Sept. 2016. <http://patient.info/doctor/eye-in-systemic-disease>.

Diabetes affects small blood vessels and can be particularly destructive in the
eye. ( 2)
Diabetes can be first detected in an eye examination ( 2)
Most diabetic eye problems lie reduced blood supply due to small vessel
blockage leading to poor delivery of oxygen, together with raised blood glucose
acting as a tissue poison. ( 2)
Ocular manifestations of diabetes can include cotton wool, hard exudates,
microaneurysms, small flame haemorrhages (European spelling of
hemorrhages), and signs of new blood vessel formation on the back of the eye.
( 3)
The first signs of hypertension are often seen in the eye where blood vessels are
clearly visible. It is not unusual for an optician to be the first to diagnose
hypertension. ( 5)
The earliest sign [of hypertension] is narrowing of the vessels the arteries then
swell and press on the veins where they cross over, causing them to look 'nipped'
at the crossings. ( 6)
Blockage causes areas of ischaemic swelling (cotton wool spots) and superficial
haemorrhages. Papilloedema occurs in severe cases. ( 6)
In hyperthyroidism, conditions like Graves' disease may cause proptosis, which
may be the first sign of the condition ( 9)
Often the first nerve to be affected by the acute demyelination of multiple
sclerosis (MS) is the optic nerve, causing optic neuritis. ( 16)
There is evidence of present or past optic neuritis in 70% of MS patients ( 17)
There are many ophthalmic features associated with AIDS which include
Kaposi's sarcoma (eyelids and conjunctiva), multiple molluscum lesions, severe
herpes zoster ophthalmicus, squamous cell carcinoma, herpes viruses,
microsporidial keratoconjunctivitis, bacterial and fungal keratitis,
cytomegalovirus keratitis, retinitis, HIV retinopathy, choroiditis, B-cell intraocular
lymphoma, and severe forms of uveitis. ( 23)
Neuro-ophthalmological problems - eg, cranial nerve palsies, pupillary
abnormalities, squints, visual field defects and visual hallucinations can also
indicate AIDS or HIV. ( 24)
Most cataracts are age-related but they are also associated with underlying
conditions. They are more common in diabetes and Down's syndrome. They may
be associated with steroid use, certain rare hormone deficiencies, previous eye
trauma, congenital rubella and many rare congenital conditions. ( 54)

Tiffany Tran
ISM- Period 1
This source wasnt very depth on many the conditions and diseases, but on some, it is very
detailed and on others, it includes basic descriptions of ocular manifestations in numerous
diseases.
"The Eye in Systemic Disease." Systemic Disease and the Eye. University of Illinois College of
Medicine, n.d. Web. 30 Sept. 2016. <http://chicago.medicine.uic.edu/cms/One.aspx?
pageId=15427346>.

The eye is composed of many different types of tissue. This unique feature
makes the eye susceptible to a wide variety of diseases as well as provides
insights into many body systems. Almost any part of the eye can give important
clues to the diagnosis of systemic diseases. Signs of a systemic disease may be
evident on the outer surface of the eye (eyelids, conjunctiva and cornea), middle
of the eye and at the back of the eye (retina). ( 2)
Common systemic diseases that affect the eye are diabetes mellitus, AIDS,
Graves disease, hypertension, sarcoidosis, sickle cell disease, multiple sclerosis
and atherosclerosis.
Diabetes can cause severe eye complications, including swelling of the retina
(macular edema), abnormal growth of new retinal blood vessels and bleeding
inside the eye. ( 6)
Changes in the blood vessels of the retina or fluctuations in vision sometimes
lead to the first diagnosis of diabetes. ( 6)
AIDS can cause infections in the eye, retinal detachment, eyelid tumors and
neuro-ophthalmic disorders. ( 7)
Abnormal retinal circulation is another frequent complication of AIDS. ( 7)
Graves disease can cause protruding eyes (proptosis), limitations of eye
movement, double vision and corneal disease. ( 8)
A type of inflammation called uveitis is the most common eye problem caused
by sarcoidosis. ( 9)
Sarcoidosis can also cause dry eyes.
High blood pressure and atherosclerosis can damage the retinal blood vessels.
( 9)
High blood pressure can be first diagnosed when changes in the blood vessels of
the eye are found. ( 9)
Sickle cell disease also can cause abnormal retinal vessels as well as bleeding
inside the retina. ( 10)
Multiple sclerosis can cause eye movement problems as well as optic nerve
disease causing loss of vision. ( 11)
Brain tumors also may affect vision by causing swelling of the optic nerve.
Occasionally, a doctor may first suspect a brain tumor after finding optic nerve
swelling on an eye exam. ( 12)

This source was described the effects some systemic diseases have on the eye, but
was not too in depth nor too vague.

Tiffany Tran
ISM- Period 1

M, Lenake. "The Eye in Systemic Disease." African Journals Online (AJOL). South African
Family Practice, 2014. Web. 30 Sept. 2016.
<http://www.ajol.info/index.php/safp/article/view/102691/92958>.

Diabetic retinopathy is the cause of blindness in approximately 2.5-million of

the estimated 50-million blind people in the world. ( 5)
Risk factors that contribute to the development of diabetic retinopathy include
the duration of diabetes, poor control of diabetes, pregnancy, hypertension,
and nephropathy.
Fundoscopy, examination after pupil dilation, allows optometrists to detect
microaneurysms, retinal haemorrhages (blot or flame-shaped), hard exudates,
cotton wool spots, changes in the calibre of the retinal veins and new vessel
formation. ( 7)
Common ocular manifestations in diabetes include: retinopathy, third palsies,
and sixth palsies.
Common ocular manifestations in HIV and AIDS include: Herpes zoster
ophthalmicus, microangiopathy, CMV retinitis, cell carcinoma of conjunctiva
and cranial nerve palsies.
Common ocular manifestations in thyroid eye disease include: Proptosis, optic
neuropathy, lid retraction, restrictive myopathies and soft tissue swelling
Common ocular manifestations in hypertension include: Disc swelling, retinal
haemorrhages, hard exudates and cotton wool spots.
Systemic diseases like diabetes, herpes zoster ophthalmicus and thyroid
ophthalmopathy often have ocular involvement. ( 30)
Therefore, it is important for the primary care physician to be familiar with
the spectrum of ocular involvement in the systemic diseases that have been
covered in this manuscript since appropriate intervention can be sight saving
for the patient. ( 30)
This article was like a pamphlet that focused greatly on a few certain diseases
to spread awareness of them, especially in Africa, and I found it very
informative.

Tiffany Tran
ISM- Period 1

Yunker, J. Jacob. Ocular Manifestations of Systemic Disease. N.d. PowerPoint Presentation.

30 Sept. 2016.

Ocular manifestations of hypertension include: cotton wool spots, retinal

hermorrhages, optic nerve swelling (edema), arteriolar narrowing along with A-V
nicking, retinal ischemia and neovascularization.
Diabetes can cause complications like macular edema and/or ischemia which
cause vision loss.
After 20 yrs: 99% of type 1 and 60% of type 2 will have some degree of DR
[diabetic retinopathy] (slide 16)
Pathologic changes include microvascular damage leading to hypoxia, vascular
leakage & edema, ischemia, and neovascularization (slide 16) refers to diabetes.
Ocular complications that can come from sickle cell disease include peripheral
retinal nonperfusion (also known as ischemia) and neovascularization which can
lead to hemorrhaging and tractional retinal detachment.
Ocular findings in thyroid diseases like Graves disease can include proptosis
(exophthalmos), lid retraction (thyroid stare), corneal exposure (dry eye, corneal
ulcer), diplopia, and optic neuropathy.
HIV/AIDS has numerous possible eye complications such as kaposi sarcoma,
molluscum contagiosum, Herpes zoster ophthalmicus, cellulitis, B-cell
lymphoma, keratitis, Keratoconjunctivitis sicca (severe dry eye), anterior uveitis,
retinitis and choroiditis.
Sarcoidosis can cause lacrimal gland granulomas, anterior uveitis, retinitis,
glaucoma and cataracts.
Multiple sclerosis can cause optic neuritis.
50% of patients with MS will develop optic neuritis. (slide 75)
20-30% of time will be presenting sign for MS. (slide 75) refers to the above
quote.
This source was very informative and credible because it was made by a welleducated doctor and included several pictures of the eye and eye conditions
caused by some systemic diseases.