Chapter 15: Ocular Disorders Associated With Systemic Diseases
List of Figures
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Figure 15-1: Flame-shaped retinal hemorrhages in the nerve fiber layer radiate out from the optic disk. Three days before the photograph was taken, the patient experienced sudden loss of vision, which left him with light perception only. |
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Figure 15-2: Ischemic optic neuropathy. Sudden visual loss in a 48-year-old man produced a complete inferior altitudinal field loss. Left: Fluorescein angiogram shows impaired filling of the upper part of the disk with dilation of retinal capillaries at the lower part of the disk. Right: Photograph 10 minutes after injection shows leakage of dye mainly at the lower part of the disk. |
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Figure 15-3: Anti-phospholipid antibody syndrome. Fluorescein angiogram demonstrates choroidal infarcts in a patient who presented with multiple strokes. |
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Figure 15-4: Cotton-wool spots. Numerous cotton-wool spots are seen in the posterior poles in three patients. Left: A young woman with acute systemic lupus erythematosus and neurologic disease. Center: A young man with pancreatitis. Right: A patient with AIDS. Cotton-wool spots resolve over 6 weeks regardless of their cause. |
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Figure 15-5: Cotton-wool spot. Histologic examination shows cytoid bodies and distended neurons in the superficial retinal layers. Deeper retinal layers are normal. (Courtesy of N Ashton.) |
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Figure 15-6: Cholesterol embolus (Hollenhorst plaque). Left: A cholesterol embolus at the optic disk, which is refractile and appears larger than the vessel that contains it. A collateral vessel is seen at the lower border of the disk. Right: Surgical specimen from a patient with a similar embolus shows an atheromatous ulcer at the bifurcation of the common carotid artery. |
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Figure 15-7: Central retinal vein occlusion. Left: Photograph shows linear hemorrhages in the nerve fiber layer and punctate hemorrhages in the deeper retinal layers. Right: Fluorescein angiogram shows dilation of the veins. |
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Figure 15-8: Retinal branch vein occlusion. The affected segment of retina shows changes of reduced perfusion. This results in irregularity of the arterioles and veins, areas of capillary closure, and dilated capillaries with microaneurysms. |
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Figure 15-9: Acute retinal infarction. Red-free photograph shows acute arterial occlusion in a congenitally anomalous vessel at the disk. The inferior retina is infarcted, but axoplasm has accumulated beneath the fovea in an irregular pattern owing to preserved neuronal function of the distal ganglion cells. |
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Figure 15-10: Accelerated hypertension. Fluorescein angiogram in a young man showing arteriolar constriction, dilation of capillaries with microaneurysms, and areas of closure. Marked disk edema is present. |
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Figure 15-11: Accelerated hypertension. Fluorescein angiogram in an elderly wom.an showing marked arteriolar constriction and irregularity but few signs of florid retinopathy. |
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Figure 15-12: A: Fluorescein angiogram of left fundus in a patient with chronic ocular ischemia secondary to Takayasu's disease. Note capillary dilation, leakage of dye, retinal hemorrhages, cotton-wool spots, and neovascularization of the optic nerve head. B: Fluorescein angiogram, showing leakage at optic disk and macula in a patient with chronic ocular ischemia secondary to dural arteriovenous fistula. |
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Figure 15-13: Subacute bacterial endocarditis. Calcific embolus impacted in arteriole below the disk, producing a distal area of retinal infarction. |
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Figure 15-14: Left: Retinal changes in chronic myeloid leukemia, where dilated veins and hemorrhages may be seen. Right: In acute lymphoblastic leukemia, infiltration of the disk may be seen. |
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Figure 15-15: Hyperviscosity syndrome. Dilated arteries and veins, with hemorrhages and microaneurysms in a patient with hyperviscosity due to elevated IgM levels. |
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Figure 15-16: Neoplastic disease. Top left: Normal fundus of a patient with rapid visual loss in his only eye. Top right: Chest x-ray showed left lower lobe consolidation and a hilar mass. Bottom: Carcinoma of the bronchus was confirmed at autopsy, and metastasis was found in the optic nerve in the region of the canal (arrows). |
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Figure 15-17: Diabetic retinopathy stage I. Trypsin-digested whole mount showing microaneurysms of the retinal capillaries. |
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Figure 15-18: Diabetic retinopathy. Fluorescein angiogram shows earliest stage with microaneurysm in the macular region. |
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Figure 15-19: Diabetic retinopathy. Fluorescein angiogram shows florid retinopathy of diabetes with extensive areas of capillary closure, dilated capillaries with microaneurysms, and early new vessel formation at the optic disk. |
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Figure 15-20: Proliferative diabetic retinopathy. Fluorescein angiogram shows extensive growth of vessels into the vitreous with marked fluorescein leakage. |
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Figure 15-21: Pupil-sparing third nerve palsy in diabetes mellitus. Sudden painful ophthalmoplegia, left ptosis, failure of adduction, and normal pupillary responses. |
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Figure 15-22: Thyroid ophthalmopathy. Left: Proptosis, visual loss, and ophthalmoplegia occurred in this elderly woman with a history of thyroid disease. Right: CT scans showed gross thickening of the ocular muscles, particularly in relation to the orbital apex. The increased intraorbital pressure is producing convexity of the medial orbital wall. |
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Figure 15-23: Keratomalacia. Case of xerophthalmia in a 5-month-old child. |
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Figure 15-24: Tuberculosis. Cold abscess. A young man presented with a swelling on his back (left) and a choroidal lesion (right). Aspiration of the abscess revealed Mycobacterium tuberculosis. |
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Figure 15-25: Sarcoidosis. Focal periphlebitis and disk leakage may respond dramatically to systemic corticosteroids. Left: Before treatment. Right: After 6 weeks of treatment with prednisolone, 30 mg daily. |
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Figure 15-26: Sarcoidosis. Retinal pigment epithelial and choroidal disease may be very distinctive (left) and highlighted by fluorescein angiography (right). |
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Figure 15-27: Leprosy keratitis, left eye. (Courtesy of W Richards.) |
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Figure 15-28: Secondary syphilis. Bilateral visual loss occurred in a 24-year-old man. Late fluorescein photographs showed disk leakage with dilation and leakage of peripapillary capillaries. |
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Figure 15-29: Toxoplasmosis. Active area of chorioretinitis adjacent to scar with reaction in adjacent retinal arteriole. |
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Figure 15-30: Retinal changes in AIDS. Multiple cotton-wool spots (left) and retinal necrosis with hemorrhage (right) due to opportunistic infection. (Courtesy of R Marsh.) |
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Figure 15-31: Polyarteritis nodosa. Bilateral sixth nerve palsies. |
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Figure 15-32: Classic Wegener's granulomatosis with proptosis, ptosis, and ophthalmoplegia. The condition has remained static for 10 years with use of cortico-steroids and cyclophosphamide. |
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Figure 15-33: Beh·et's disease. Clinical features include oral and genital ulcers. Ocular features include increased capillary permeability and areas of retinal ischemia and infiltration. Marked leakage of capillaries is seen in the late stages of fluorescein angiography (bottom right). |
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Figure 15-34: Marfan's syndrome. Familial expression of arachnodactyly and upward dislocation of the lens. |
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Figure 15-35: Vogt-Koyanagi-Harada syndrome. Acute pigment epithelial disease with disk swelling and cells in the vitreous (left). Three months later, disk swelling has subsided and pigment epithelial damage is seen (right). |
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Figure 15-36: Retinitis in an immunosuppressed patient. Left: This patient with myasthenia gravis underwent thymectomy and received long-term immunosuppression with cytotoxic agents. Right: He developed retinal necrosis and Ramsay Hunt syndrome following infection with herpes zoster. |
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Figure 15-37: Amiodarone keratopathy. (Courtesy of DJ Spalton.) |
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10.1036/1535-8860.ch15