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Ocular Manifestations & Systemic Diseases in Ophthalmology

Learn about HIV retinopathy, CMV, toxoplasmosis, JIA, Marfan disease, myasthenia gravis, methanol poisoning, chloroquine, hypertension, and their impact on ocular health. Explore symptoms, diagnosis, and treatment options.

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Ocular Manifestations & Systemic Diseases in Ophthalmology

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  1. Systemic disease in ophtlhalmology mrniyousha. MD

  2. HIV ocular manifestation • 1 . HIV retinopathy • 2- Opportunistic Infections

  3. Ocular disease occurs in 50–75% of HIV-infected patients • The most common manifestation is HIV microvasculopathy, followed • by cytomegalovirus (CMV) retinitis, ocular toxoplasmosis, non-CMV herpetic retinitis, herpes zoster ophthalmicus(HZO), and ocular neoplasia

  4. HIV microvasculopathy • Hypotheses regarding the pathogenesis of retinal microvasculopathy include : • HIV-induced increase in plasma viscosity, • HIV-related immune complex deposition

  5. The clinical spectrum of HIV retinopathy includes • infarct of the nerve fiber layer (often called cotton-wool spots), • retinal hemorrhages, • telangiectasia, • lack of capillary perfusion, • vascular occlusion

  6. CMV • The most common AIDS-related opportunistic infection and remains an important cause of visual morbidity. • CMV retinitis frequently occurs in AIDS patients with a CD4+ count <50 • cells/uL and is the most common ocular opportunistic infection associated with AIDS

  7. Toxoplasmosis • Larger lesions • Bilateral more common • Lower inflammation • Multiple lesions

  8. JIA • Pauci - articular • poly – articular • Still disease

  9. JIA • Eye is usually quiet . • 10 – 15 % chronic uveitis • periodic ocular examination is needed.

  10. Risk factors • Female • Pauci articular • ANA + • RF

  11. Treatment • Corticosteroids • Long lasting flair • Mydriatic • NSAIDs and Imunomedulatory Drugs

  12. Marfan Disease • AD • Zonolysis • Lens Subluxation • Retinal detachment

  13. The most important one to be differentiated from Marfan • syndrome is surely homocystinuria. • lens dislocation is usually • downward—atypical for Marfan syndrome

  14. Marfan disease • Retinal detachment is the most serious ocular complication in Marfan syndrome. • The incidence lies between 8% and 25.6% • It is more common in the younger age, with an average age of 22 years.

  15. Myastenia Gravis • Auto immune disorder • Female > male • 3rd and 4th decade • Circulating Antibodies against Neuromuscular junction • Muscle weakness • Improvement with rest Evening worse than morning

  16. Myastenia Gravis • Ocular involvement in 90% of patients • 60% ocular manifestation is first manifestation • Deteriorates by β Blocker , CCB, Aminoglycosides , Corticosteroids

  17. Ocular manifestation • Ptosis • Unilateral and bilateral • Symmetric or nonsymmetric • Diplopia • Any kind of strabismus • Pupil involvement

  18. Diagnosis • Tensilon test • Sleep test • Ice test • Circulating auto antibodies

  19. Paraclinic • CT scan of chest and neck • Search for thymoma

  20. Methanol Poisoning • Max serum level • 30- 60 min • Max toxic effect • 12 – 24 hr • 20 cc can cause death • 15 cc can cause blindness

  21. Methanol Poisoning • Acidosis and vision loss • Vision loss and constricted visual field • Complete blindness

  22. Methanol Poisoning • Pupil reaction is reduced • Ocular Muscles paresis and ptosis may happen • Metabolic injury to optic nerve and retina • Optic disk Hyperemia

  23. Treatment • Gastric lavage • Acidosis treatment Ethanol Hemodialysis So methanol level is not detectable

  24. Vit B12 1000 mg daily • Acid folic 1mg daily • Corticosteroid 2mg/kg

  25. Chloroquine • Central visual loss : Maculopathy • Depends on total dosage used • Hydroxychloroquine better tolerated

  26. Chloroquine Slit lamp examination Macular pigmentary changes Examination every 6 months

  27. May be Non Reversible • May progress despite halting the drug • Bull eye maculopathy

  28. Corticosteroids • Cataract • Glaucoma • Hepes simplex recurrences • Keratitis

  29. Hypertension • Hypertension directly affects the retinal and choroidalcirculations, causing hypertensive • retinopathy and choroidopathy. Hypertension is associated with : acceleration of diabetic retinopathy and • increases the risk of retinal vascular occlusion, • ischemic optic neuropathy, • retinal artery macroaneurysm

  30. Because hypertension is frequently asymptomatic, the presenting signs or symptoms • may be visual • Hypertensive retinopathy is the most common ophthalmic manifestation of hypertension • with a reported prevalence of 2–14% in nondiabetic adults over age 40 years • Hypertensive retinopathy is associated with increased risks of stroke, cognitive impairment, and cardiovascular death

  31. Initially, retinal arteriolar constriction occurs as part of an autoregulatory mechanism. • With continued disease, breakdown of the inner blood-retinal barrier • occurs, with subsequent hemorrhages and exudates, followed by retinal edema • In advanced cases, optic nerve edema (hypertensive optic neuropathy) may ensue, which is caused by ischemia leading to axonal edema

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