Ocular manifestation of systemic diseases

Source:  Ocular manifestation of systemic diseases    Tag:  cmv retinopathy

Ocular manifestation of systemic diseases.

Eyes are the windows of the body. Many occurrence of the body can be seen through the eyes. On the other way we can tell the abnormality of the different systems of the body on examining the eye.

A. Deficency disease:

Vitamin – A

Xerophthalmia – It is a disease complex occurring in eye due to defiency of vitamin A. It is usually associated with PEM. It may occur up to 6 years, but prevalence is more among 6 months to 3 years. It is also called Keratomalacia.

Signs of keratomalacia according to WHO are –
XN – Night blindness,
XIA – Conjunctiva xerosis,
XIB – Bitot’s spot,
X2 – Corneal xerosis,
X3A – Corneal ulceration or melting,< 1/3 cornea,
X3B – Corneal ulceration or melting,> 1/3 cornea,
XS – Corneal scar,
XF – Xerophthalmic fundus. Small white lesion on retina and may associated with constriction of visual field.

XN –Night blindness or “chicken eyes”( lack of rods), Vitamin A + protein = visual purple ‘rodopsin’> responsible for night blindness.

Daily requirment of vit – A:0-4 years= 1000 – 2000 iu, School children &adult =2250 iu, Pregnancy & lactation =3000 – 3500 iu.

Bitot’s spot : Whitish raised foamy triangular spot, base towards limbus, situated on the temporal side of the eyeball. It also occur in adult in excessive meibomian secretion.

Nutritional blindness : Blindness due to lack of nutrition specially due to vit. A deficiency.

Treatment of keratomalasia.

Medical emergency, high risk of corneal destruction and blindness.

1.Massive dose of vit, A according to WHO recommendation :

1st day – 200000 iu,

2nd day – 200000 iu,

14th day – 200000 iu.

Children of 6 - 11 months or < 8 kg. = ½ the above dose.
Children of less then 6 months = ¼ the above dose.

2. Eye care : If cornea is involved –
Local antibiotic,
Topical atropine,
Other symptomatic treatment.

3. Diet and other measure :
Easily digestible protein rich frequent meals,
Correction of dehydration, infection, diorrhoea, worm infestation.

4. Preventive measure :

High potency vit. A (100000) i.u every 6 month interval up to 6 years,
Vitamin A rich diet.

Other vitamin deficiency.

Vit.B1 : è Retrobulber neuritis, corneal hyposthesia, ophthalmoplagia.

Vit. B2 : è Corneal vuscularisation, keratitis, s.p.k., blepharo-conjunctivitis, burning eye.

Vit. B12 : èRetrobulber neuritis.

Vit. C : è Heamorrhage in orbit, conjunctiva & retina.

Vit. D : è Zonular cataract in rickets.

B. Infective disease:

1.Tuberculosis è Inflammation of any structure of eye, optic atrophy, papilloedema.

2.Syphilis è Chancre of conjunctiva, iritis & nodule on iris, arzylrobertson pupil, ocular pulsy & optic atrophy.

3. Laprosy è Cuteneous nodules over eyelids, falling of hair of eyebrow and eye lashes, inflammation of any structure of eye.

4. Diptheria è Membranous conjunctivitis, cycloplagia.

5. Aids : è Ocular complication occur in 75% of Aids patients,

Retinal micro vusculopathy e.g cotton wool spot, superficial & deep hge.,

Kaposi’s sarcoma over lid & conjunctiva.

Opportunistic infection e.g CMV retinitis is the most common opportunistic infection and the major cause of visual loss in AIDS patient.

Most of the AIDS patient dye within 6 to 8 weeks of appearance of this sign.

6. Whooping cough : è Conjunctival, retinal and orbital hemorrhage.

7. Dengue fever : è Optic neuritis, infective retinitis & hge.

8. Measles è Sub.conj.hge, koplic spot on conjunctiva.

9. Mumps è Acute decroadenitis, uveitis.

10. Small pox :è corneal ulcer.

11. Malaria : è Retinal hge. Optic neuritis

12. Kala-azar è Retinal hemorrhage.

13. Toxoplasmosis è Narcotizing chorio retinitis (infants), uveitis (adults).

14. Steven-Johnson's syndrome : è Conjunctivitis, corneal ulcer, necrosis.

C. Metabolic diseases :
1.Gout and rheumatism: è Episcleritis, scleritis, uveitis.
2.Diabetes mellitus è Hyper matropia when blood sugar decrease, Myopia when blood sugar increase. Rubiosis iridis, Cataract, Diabetic retinopathy=micro anurism,dot hemorrhage, hard waxy exudates, Extra ocular muscle paralysis, Optic nuritis, Optic atrophy.
3.Disease of the liver : è Yellow coloration of the conjunctiva.

D. Disease of the CVS:

1.Hypertension: è Hypertensive retinopathy :

GI = Mild generalized arteriolar narrowing (attenuation),

GII = Arteriolar attenuation+AV nicking,

GIII = Gread II+flame shaped hge+cotton wool exudates,

GIV = GIII+papilloedema.

2. Arteriolar sclerosis: è Copper wire arteriole, Silver wire arteriole.

E. Blood Diseases:
1.Leukemia è Sub conjunctival hge., proptosis.
2.Pernicious anaemia è Retinal hge.with central white spot.
3.Haemophilia èSub conjunctival,retinal and orbital hge,
4.Great loss of blood èAmblyopia or amaurosis and may followed by bilateral optic atrophy.

F. Disease of the kidney:
  1. Nephritis è Passive oedema lid,
  2. Retinopathy

Flame shaped hge,

Wooly exudates,


G. Toxemia of pregnancy:

1. Sudden black out – retinal arteriolar spasm,

2. Retinopathy – flame shaped hge,

Cotton wool exudates,


H. Intra cranial lesion :
1.Raised intracranial pressure è
pupil dilated & fixed (Hutchinson pupil ),
If pressure rise more other pupil dilates,

2. If cranial nerve affects è
Visual field defect (if visual pathway is affected by pressure)
Ocular muscle palsy – 6th. Is more vernarable.

3. Pulsating exopthalmos è carotico cavernous fistula.
I. Muscular disease :
  1. Myasthenia gravis è


Ocular muscle paresis,

* (Tensilon test to exclude myasthenia gravis – Improvement of ptosis with I.V injection of tensilon,i.e edrophonium, if the ptosis is due to myasthenia.)
J. Endocrine Disease :
1.Thyrotoxicosis or grave disease è

Bilateral exophthalmoses,

Retraction of upper eye lid,

Lid lag.

Measurement of exophthalmoses :

Lateral orbital margin to apex of the cornea = up to 20 mm. In proptosis it is more than 20 mm, or difference of corneal apex is more than 2 mm in two eyes. Exophthalmoses is due to – deposition of hydrophilic mucopolysaccaride & inflammatory cells in orbital tissue .