Ocular Manifestation of Systemic diseases

The eyes are frequently involved in diseases affecting the rest of the body
Ocular manifestations in certain multisystem disorders may offer a diagnostic clue
Sometime the eye involvement may be subtle enough to avoid detection unless the clinicians knows to look for it.

CORNEA RELATED TO SYSTEMIC DISEASES

DISEASES OF THE SKIN AND MUCOUS MEMBRANES
Atopic dermatitis, cicatricial pemphigoid, epidermolysis bullosa, erythema multiforme
DISORDERS OF COLLAGEN METABOLISM
Ehlers-Danlos syndrome, Marfan syndrome
COLLAGEN DISEASES
Dermatomyositis, periarteritis nodosa,rheumatoid arthritis, SLE
METABOLIC DISEASES
Amyloidosis, cystinosis, glycogen storage disease, gout, hyperlipidemia

CATARACT RELATED TO SYSTEMIC DISEASES
METABOLIC AND NUTRITION DISEASES
Aminoaciduria, diabetes mellitus, galactosemia, hypoparathyroidism, hypothyroidism, Wilson’s disease
INFECTIOUS DISEASES
Congenital HSV, syphylis, CMV, rubella
TOXIC SUBSTANCES

RETINA RELATED TO SYSTEMIC DISEASES
CARDIOVASCULAR DISEASES
Aortic arch syndrome, hypertension and toxaemia
of pregnancy, occlusive vascular disease
COLLAGEN DISEASES
Dermatomyosistis, periarteritis nodosa, SLE, temporal
arteritis, Wegener granulomatosis
ENDOCRINE DISEASES
Diabetes mellitus, Cushing syndrome,
hyperthyroidism, hypothyroidism, hypoparathyroidism
DISEASES OF THE SKIN AND MUCOUS MEMBRANES
Pseudoxanthoma elasticum
GASTROINTESTINAL AND NUTRITIONAL DISEASES
Regional enteritis, vitamin A deficiency
HEMATOLOGIC DISEASES
Anaemias, leukemias, sickle cell disease, thrombocytopenia
INFECTIOUS DISEASES
Candida retinitis, parasites, viral infections, tuberculosis, HIV, HSV, HZV, CMV
PHAKOMATOSES
METABOLIC DISEASES

THYROID EYE DISEASE (Graves’ ophthalmopathy)
The diagnosis may not be obvious, although it is quite common!
The severity of the eye changes does not always relate to the severity of the endocrine problem
It is not known why some patients with thyroid imbalance have eye features and others do not
The link is immunological, though the details are unclear
Often the eye features develop out of phase with the thyroid

PATHOGENESIS OF THYROID EYE DISEASE
The disease is not completely understood
The existing knowledge suggests that the disease is likely to be
autoimmune in origin and linked to autoimmune thyroid disease
Cigarette smoking is commoner among patients with Graves’
disease and smokers have a more severe ophthalmopathy
Orbital fibroblasts synthesize more glycosaminoglycans when
cultured under hypoxic conditions.
Glycosaminoglycans attract water ? swelling of extraocular
muscles
Infiltration of orbital tissue by immune cells ant their activation, with
subsequent cytokine release leads to local cell proliferation

OPHTHALMIC PROBLEMES IN NEUROLOGICAL DISORDERS
Multiple sclerosis -Optic (ON) neuritis is the most common manifestation (usually unilateral, but may be bilateral) and the presenting feature in about 25% of MS patients
About 60% of patients in the 20-40 years age group who present with ON will subsequently develop evidence of systemic demyelinisation!

Stroke - Homonymous hemianopia is the commonest finding
Often not recognized by the patient
Lesion within the optic path behind the chiasm (usually in the radiation passing through temporal and parietal areas to the occipital cortex)
Occlusion of the vertebrobasilar circulation may cause bilateral cortical lesions and marked visual disability
Many patients have reading difficulties

Intracranial tumors
Benign intracranial hypertension
Facial palsy


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