‫بسم ال الرحمن ا لرحيــــــم‬

Eye Manifestasion of
Systemic Diseases
By
Dr.Ahmed Noureldin Ahmed
MBBS,DCH,DTM&H
Umm-Ghoilina H.C
 Anatomy
.
 Anatomy
.
 Uveal Tract
:Consists of
Iris- 1
Ciliary Body- 2
Choroid- 3
 Cross section
.
 Iris
.
 Anterior Uveitis
.
 Iritis , uveitis & Choroiditis
If the iris alone is inflamed.
(Iritis)
If the ciliary body is involved
()Iridocyclitis
If the entire uveal tract
.” (Uveitis)
 Uveitis
is related to a disease or infection in another part of
the body such as arthritis, TB ,$ , ankylosing
spondylitis, Reiter’s syndrome, toxoplasmosis,
histoplasmosis, cytomegalovirus (CMV),
. sarcoidosis, and toxocariasis
nfection of some parts of the body (tonsils, sinus,
kidney, gallbladder, and teeth) also can cause
.inflammation of the iris or of the entire uveal tract
 Symptoms of Iritis
Photophobia and ciliary injection of straight
deep vessels radiating from the limbus.
The pupil is small and poorly reactive
because of inflammation and distant vision
may be impaired. On slit lamp
examination, white precipitates can be
visualized on the posterior surface of the
cornea, and inflammatory cells in the
anterior chamber. Topical anesthetic will
. not relieve pain
 Treatment
Steroids and anti-inflammatory drops are •
prescribed to reduce inflammation in the
eye. Dilating drops also make the eye
more comfortable by relaxing the muscle
. .that constricts the pupil
Iritis must be treated to avoid permanent •
problems such as scarring inside the
. eye
 Ankylosing Sponylitis
a common cause of anterior uveitis,
produces eye pain, redness, photophobia,
and decreased vision, usually in one eye.
There is an association with HLA-B27 -
associated diseases, including psoriatic
arthritis, inflammatory bowel disease, and
Reiter's syndrome, which includes the
triad of conjunctivitis/uveitis, arthritis,
and urethritis.Treatment is with local
. corticosteroids and cycloplegics
Juvenile Rheumatoid Arthritis
causes chronic bilateral iridocyclitis. it does
not produce pain, photophobia, and
conjunctival injection and has, therefore,
been called the white iritis. more than 80%
have a positive ANA titer .Inflammatory
exacerbations require treatment with local
. corticosteroids and cycloplegics
 Behçet's syndrome
severe anterior uveitis with hypopyon, retinal
vasculitis, and optic neuritis.The clinical course
is usually severe, with multiple recurrences. The
associated systemic manifestations, such as oral
aphthous ulcers or genital ulcers; erythema
nodosum; thrombophlebitis; or epididymitis
Treatment with local and systemic corticosteroids
along with cycloplegics may alleviate intraocular
.inflammation.Cyclosporin may be given
 Macula
.
 Age-Related Macular
(Degeneration )ARMD
.Most common cause of vision loss over age 65
symptoms can include blurred vision, image
distortion (metamorphopsia), central scotoma,
and trouble reading. Risk factors: age, family
history, cardiovascular disease, smoking, UV
light, blue eyes, and antioxidant vitamin
.deficiency
 ARMD
.
 ARMD
.
 Treatment
Antioxidant supplements may help prevent
.ARMD
Patients above age 65 should see an eye
doctor annually and use an Amsler grid
periodically to self check for vision
. problems
Laser photocoagulation in can reduce
severe vision loss
 Scleritis
is an inflammatory disease that affects the
Conjunctiva , sclera and episclera
It is associated with underlying systemic
.diseases in about half of the cases
The diagnosis of scleritis may lead to the
detection of underlying systemic disease.
Rarely, scleritis is associated with an
.infectious problem
 Scleritis
.
 Signs and Symptoms
Severe, boring pain •
Local or general redness of the sclera and •
conjunctiva
Extreme tenderness •
)Photophobia (in some cases •
Decreased vision •
 Treatment
Scleritis is treated with oral steroid and
NSAIDs to reduce inflammation. Eye
drops alone do not provide adequate
treatment. In very severe cases of
necrotizing scleritis, surgery may be
required to graft scleral or corneal tissue
over the area of thinned sclera
 Diabetic eye Disease
Diabetes can affect the eyes in a number of ways. The
most common and characteristic is
.Diabetic Retinopathy
;Other forms of diabetic Eye disease
The Lens :may be affected by reversible osmotic►
changes in patients with acute hyperglycaemia,
.causing blurred vision or by cataract
Rubiosis Iridis:as a late complication of diabetic►
.retinopathy and can cause glaucoma
6th nerve Palsy : due to mononeuropathy►
 Rubiosis Iridis
.
 Natural History of D.R
Diabetes causes increased thickness of the
capillary basement membrane and increased
permeability of the retinal capillaries.
Aneurysmal dilatation may occur in some
vessels, while others become occluded. These
changes are first detectable by fluorescein
angiography. After 20 years of type 1 diabetes,
almost all patients have some retinopathy
Without treatment, 50% of proliferative patients
. become blind within 5 years
 Background retinopathy

.
 Features of Diabetic Eye Disease
a) Normal Macula and Optic Disc

b) Dot and blot hge

(early background retinopathy(

c( Hard Exudates
(Background Retinopathy)

d( Multiple Cotton – wool Spots

.(Preproliferative Retinopathy)
Features of Diabetic Eye Disease

.
Features of Diabetic Eye Disease
e) New Vessel formation
)Advanced Retinopathy(

f) Exudative Maculopathy

g) Central Cataract

h) Cortical Cataract
 Pathological Changes

.
 Diabetic Retinopathy
The first abnormality visible through the
ophthalmoscope is the appearance of dot
'haemorrhages', which are actually due to
capillary microaneurysms. Leakage of blood into
the deeper layers of the retina produces the
characteristic 'blot' haemorrhage, while
exudation of fluid rich in lipids and protein give
rise to hard exudates. These have a bright
yellowish white colour and are often irregular in
. .outline with a sharply defined margin
 Diabetic Retinopathy
Background retinopathy does not in itself constitute a threat
:to vision but may progress to two other distinct forms
maculopathy or proliferative retinopathy. Both are due
to damage to retinal vessels and resultant ret.ischemia
This may lead to blindness and affects the older patient
with type 2 diabetes. Macular oedema is the first feature
of maculopathy and may in itself result in permanent
macular damage if not treated early. The first, and only,
sign of this is deteriorating visual acuity and this early
condition cannot be diagnosed with standard
ophthalmoscopy. This is why it is essential to screen
. .patients regularly for changes in visual acuity
 Pre-Proliferative
Progressive retinal ischaemia will, in some
patients, cause background retinopathy to
progress to pre-proliferative, sight-threatening
retinopathy. The earliest sign is the appearance
of 'cotton-wool spots. Cotton-wool spots are
greyish white, and a dull matt surface, unlike
. .the glossy appearance of hard exudates
 Proliferative retinopathy
Hypoxia is the signal for formation of new
vessels. These lie superficially or grow
.forward into the vitreous
With advanced retinopathy, haemorrhages
can be preretinal or into the vitreous.
vitreous haemorrhage presents as a loss
of vision in one eye, sometimes noticed on
waking, or as a floating shadow affecting
.the field of vision
 Normal Lens
.
 Cataract
Senile Cataract :develops earlier in diabetic ►
. patients than in the remainder of the population
Juvenile Cataract: are diffuse, rapidly►
progressive cataracts associated with very
.poorly controlled diabetes
They should be distinguished from temporary
lens changes that occasionally appear during
hyperosmolar states and resolve when the
.hyperglycaemia is brought under control
Cataract
.
 Examination
systematic examination of the eye is
essential. Visual acuity and eye
movements are tested, the pupils are
dilated with a mydriatic such as
tropicamide 0.5%. but should not be used,
in patients with a history of glaucoma.
The ophthalmologic examination begins at
. arm's length
 Examination
The ophthalmoscope is advanced until the retina is
in focus. The examination begins at the optic
disc, moves through each quadrant in turn, and
ends with the macula (since this is least
comfortable for the patient). The
ophthalmoscope is then adjusted to the +10
dioptre lens for examination of the cornea,
.anterior chamber and lens
All patients with retinopathy should be examined
. .regularly by a diabetologist or ophthalmologist
 Early referral to an
ophthalmologist is essential in
:-the following
.Deteriorating Visual Acuity- 1

Hard Exudate encroaching on the Macula- 2

pre-proliferative changes )cotton-wool- 3

(spots or venous beading

new vessel formation- 4

 .
The ophthalmologist may perform
fluorescein angiography to define the
extent of the problem. Maculopathy and
proliferative retinopathy are often
treatable by retinal laser photocoagulation;
in the latter condition early effective
therapy reduces the risk of visual loss by
.about 50%
The value of photocoagulation is.
particularly marked in those with disc (as
. .against peripheral) new vessels
 Hypertensive Retinopathy
Cotton – wool Spots and
.Flame – shaped hge
?what is this- 4
.
?What is this-5
.
?What is this- 6
.
?And this-7
.
 Answers
Proliferative retinopathy- 4
Non-proliferative Retinopathy- 5
Pre-Proliferative Retinopathy- 6
Acute Congestive Gjaucoma-7
.