Eye Manifestations in Systemic Diseases

Dr. Amira Elagamy

 Eye Manifestations in Systemic Diseases

 Infectious diseases.

 Blood disorders.
 Collagen diseases.
 Endocrine disorders.

 Metabolic diseases.
 Nutritional deficiencies.
 Intoxications.

 Infectious diseases.
 Infectious Diseases
Kerato-Conjunctivitis Sub-conjunctival Hemorrhage

 Viral infections as measles,

chicken pox and rubella.
 Granulomatous infections
tuberculosis and syphilis.
 Hemorrhagic fevers as in Rift
valley fever, Ebola virus, and
as
spirochetal diseases.
Uveitis

•  
 Retinitis

Cytomegalovirus
Retinitis in AIDS

   
 Optic Neuritis and
•  
Subsequently Optic Atrophy

 Encephalitis and meningitis of

viral or bacterial origin.

Dr. Amira El-Agamy

Assistant Professor of Ophthalmology
 Blood Diseases
Coagulation Disorders •  

As hemophilia, thrombocytopenia
and anti-coagulant therapy can
produce hemorrhage anywhere in
the eye. The most significant of
which are vitreous and retinal
hemorrhages.
 Hematological Malignancies

As leukemias and lymphomas can produce a wide variety of manifestations

including:

 Sub-conjunctival hemorrhage.
 Orbital infiltrations and proptosis.
 Uveal nodules
 Retinal pale-centered hemorrhages (Roth spots)(it is a hemorrhage in the
retina with a white center which is caused immune complex mediated
vasculitis).
 Collagen Diseases
 This is a group of diseases involving the joints and connective tissue all-over the
body. They include rheumatoid arthritis, systemic lupus erythematosus,
polyarteritis nodosa, scleroderma, polymyositis and Sjogren syndrome.
 Dry eye (Kerato-Conjunctivitis Sicca) is due to loss of the watery
component of tears due to atrophy of the main and accessory lacrimal glands.
 Keratitis, keratolysis, spontaneous sterile corneal perforations and scleritis.
 Irido-cyclitis is common with juvenile rheumatoid arthritis.
 Systemic lupus erythematosus and polyarteritis nodosa produce a variety of retinal
and choroidal vascular occlusions with the most common manifestation being
cotton-wool spots of the retina.
 Endocrinal Disorders
 Cataract  Diabetes: Retinal changes
 Diabetes  Pituitary Chromophobe
 Cushing's syndrome
 Hypo-para-thyroidism.
Adenoma: Optic nerve
compression and bitemporal
 Dysthyroid Eye Disease: hemianopia.
Proptosis and extra-ocular muscle
disorders.
 Ocular Manifestations of
Diabetes Mellitus
 Lids
 Recurrent styes.
 Xanthelasma.
 Blepharitis.
 Cornea: Recurrent corneal erosions.
 Iris
 Rubeosis iridis.
 Diabetic iritis.
 Retina: Diabetic retinopathy
•  
 Metabolic Diseases
Cataract Subluxated Lens

 Galactosemia  Marfan's syndrome

 Oculocerebrorenal dystrophy (Lowe's  Homocystinuria.
syndrome)
 Wilson's disease (sun-flower
cataract).
•  
 Muco-poly-saccharidosis: Corneal infiltrates and edema

 Cystinosis: Corneal crystals

 Hyper-lipidemias: Lid nodules (xanthelasma)
 Cherry-red spot of the fovea
 Sphingo-lipidoses such as Niemann-Pick disease
 Muco-lipidoses.

 Optic atrophy: It is common in many end-stage metabolic disorders.

 The cherry-red spot refers to the reddish area at the center of macula surrounded
by retinal opacification in certain disorders. The retinal opacification may be due to
various causes, including accumulation of different materials in the ganglion cells
in storage disorders and retinal ischemia/infarction as in central retinal arterial
occlusion (CRAO).
 Nutritional Deficiencies
 Vitamin A Deficiency
 Xerosis of the conjunctiva (Bitot’s spots).
 Keratomalacia in severe cases.
 Night blindness.

 Severe vitamin-B Deficiency

 Ophthalmoplegia.
 Various scotomas.
 Optic atrophy.

 Deficiency of vitamin C and other anti-oxidants

 Cataract
 Age-related macular degeneration (ARMD).
 Drug and Chemical Intoxication
 Blepharo-conjunctivitis

 Allergy (with the use of sulphonamides)

 Darkening of the conjunctiva (Argyrosis) (silver preparation)
 Lid and conjunctival pigmentation (anti-glaucoma medication)
 Bacterial and fungal infections (immuno-suppressive drugs)
 Corneal deposits

 Amiodarone therapy (antiarrhythmic)(vortex Keratopathy).

 Hydroxychloroquine toxicity.
•  
 Papilledema and increased intra-cranial tension
 Vitamin A
 Corticosteroids
 Tetracyclines
 Optic atrophy
 Methyl alcohol
 Lead poisoning
 Anti-tuberculous drugs
 Retinal toxicity
 Phenothiazines (pigmentary retinopathy)
 Chloroquines (Bull’s eye maculopathy)
 Tamoxifen (Crystalline maculopathy)