1 / 35

Ocular Manifestations of Systemic Diseases

Ocular Manifestations of Systemic Diseases. Dalman. Dysthyroid Orbitopathy. autoimmune disorder usually associated with Graves' disease 10-25% euthyroid extra-ocular muscles are the target of the autoimmune attack  restrictive ophthalmoplegia and proptosis Cardinal Signs

masato
Télécharger la présentation

Ocular Manifestations of Systemic Diseases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ocular Manifestations of Systemic Diseases Dalman

  2. DysthyroidOrbitopathy • autoimmune disorder usually associated with Graves' disease • 10-25% euthyroid • extra-ocular muscles are the target of the autoimmune attack  restrictive ophthalmoplegia and proptosis • Cardinal Signs • upper eyelid retraction and lag, conjunctival injection and chemosis, and periorbital edema.

  3. DysthyroidOrbitopathy • Pathophysiology • antibody-mediated reaction against the TSH receptor with orbital fibroblast modulation of T-cell lymphocytes

  4. DysthyroidOrbitopathy • Pathophysiology T- cells inflammation Thyroid cells Hyperosmotic shift Orbital fibroblast EOM edema cytokines mucopolysaccharides

  5. DysthyroidOrbitopathy • Pathophysiology Preadipocyte fibroblasts adipocytes Inc. orbital volume Inc. fat proptosis lagophthalmos edema Tissue damage and fibrosis EO motility restriction

  6. DysthyroidOrbitopathy

  7. DysthyroidOrbitopathy

  8. DysthyroidOrbitopathy

  9. DysthyroidOrbitopathy • Management • self-limited (over 1 year) • No immediate cure available

  10. DysthyroidOrbitopathy • Management • Orbital radiation • moderate-to-severe inflammatory symptoms, diplopia, and visual loss in patients with TAO • Optic nerve compression • High-dose steroids (proceed to surgery if unresponsive) • Surgical • Orbital decompression • Strabismus surgery • Lid lengthening • Blepharoplasty

  11. Occular Changes in Hypertension • Damage to the retina caused by high blood pressure • 3 manifestations • Hypertensive retinopathy • Hypertensive optic neuropathy • Hypertensive choroidopathy

  12. Occular Changes in Hypertension • Pathophysiology • Retinal microvasculature Inc BP Hyperoxic & hypercapneic stress Bifurcation angles and retinal arteriolar diameters show Dec vascular reactivity Disadvantageous branching geometry in retinal vasculature

  13. Occular Changes in Hypertension • Pathophysiology • Dynamics of ocular blood flow Hypertensive arterial changes Inc resistance to optic nerve head blood flow Inc BP Breakdown of autoregulation

  14. Occular Changes in Hypertension • Pathophysiology • Different manifestations because • Acute HTN disrupts blood-retinal barriers • Retinal and optic nerve head vascular beds have autoregulation (choroidal has none) • Choroidal vessels has no blood-ocular barrier • Retinal vessels (no autonomic nerve supply) • Choroidal vessels (richly supplied by both sympathetic and parasympathetic nerves)

  15. Hypertensive Retinopathy • Represents target-organ damage

  16. Grade II

  17. Grade III

  18. Grade IV

  19. Hypertensive Retinopathy • Clinical features • Vasoconstriction • Fundus • focal and generalised arteriolar narrowing, microaneurysms, intraretinal hemorrhages, cotton-wool spots, hard exudates, optic disc swelling • 2o to arteriolosclerosis  arteriovenous nipping • Flame-shaped hemorrhages (abnormal vascular permeability) • Macular star (lipid deposition around the fovea) • Disc swelling (minimal microvascular change)

  20. Cotton-wool spots

  21. Hypertensive Retinopathy • Clinical features • Vasoconstriction • Fundus • Untreated hypertension  hemorrhagic detachment of retina and vitreous hemorrhage

  22. Hypertensive Retinopathy • Clinical features • Vasoconstriction • Fundus • Secondary arteriosclerosis • Bonnet’s sign - banking of the venule distal to the crossing • Gunn’s sign - nipping of the blood column • Salus’ sign - displacement of the venule at right angles to the arteriole

  23. Hypertensive Retinopathy • Gunn’s sign and Bonnet’s sign

  24. Hypertensive Retinopathy • Focal arterial narrowing of the retina

  25. Hypertensive Optic Neuropathy • Papilloedema or bilateral disc swelling • Grade IV hypertensive retinopathy • Poor prognostic sign • Other causes like space-occupying lesions and benign intracranial HTN should be excluded • Theories on the pathophysiology • Ischemia and raised ICP as a part of hypertensive retinopathy/enchephalopathy

  26. Hypertensive Optic Neuropathy • Usually resolve following control of BP, but some might develop disc pallor • Longstanding uncontrolled HTN  retinal nerve fiber loss

  27. Hypertensive Choroidopathy • Less well recognized than retinopathy • Commonly described features: • Choroidal vascular sclerosis • Elschnig spots – focal areas of degenerative retinal pigment epithelium • Siegrist’s streaks – linear pigment epithelial changes • poor prognosis

  28. Hypertensive Choroidopathy • Elschnig spots

  29. Management • Control hypertension • Grade I and II • Non-urgent referral • Grade III • More urgent referral to the GP • Grade IV • Patient is in medical crisis. Patient needs immediate referral to a hospital eye casualty department

More Related