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Systemic disease in ophtlhalmology

Systemic disease in ophtlhalmology. mr niyousha . MD. HIV ocular manifestation. 1 . HIV retinopathy 2- Opportunistic Infections. Ocular disease occurs in 50–75% of HIV-infected patients The most common manifestation is HIV microvasculopathy , followed

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Systemic disease in ophtlhalmology

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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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