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Eye Manifestasion of Systemic Diseases
By Dr.Ahmed Noureldin Ahmed MBBS,DCH,DTM&H Umm-Ghoilina H.C

Anatomy
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Anatomy
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Uveal Tract
:Consists of Iris- 1 Ciliary Body- 2 Choroid- 3

Cross section
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Iris
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Anterior Uveitis
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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
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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
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ARMD
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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
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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
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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
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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
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Features of Diabetic Eye Disease
e) New Vessel formation )Advanced Retinopathy( f) Exudative Maculopathy g) Central Cataract h) Cortical Cataract

Pathological Changes
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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
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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
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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

. perform The ophthalmologist may
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
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?What is this-5
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?What is this- 6
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?And this-7
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Answers
Proliferative retinopathy- 4 Non-proliferative Retinopathy- 5 Pre-Proliferative Retinopathy- 6 Acute Congestive Gjaucoma-7

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