Transcript homonymous hemianopia

 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
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
 The
most severe of ocular complications
of diabetes
 Caused by damage to blood vessels of
the retina, leads to retinal damage
 Microvascular complication of
longstanding diabetes mellitus
 Most prevalence cause of legal
blindness between the ages of 20 and
65 years
 Common in DM type 1 > type 2

Duration of diabetes
› Most important

Poor metabolic control
› Less important, but relevant to development and
progression of DR
›  HbA1c ass. with  risk

Pregnancy
› Ass with rapid progression of DR
› Predicating factors : poor pre-pregnancy control of
DM, too rapid control during the early stages of
pregnancy, pre-eclampsia and fluid imbalance

Hypertension
› Very common in patients with DM type 2
› Should strictly control (<140/80 mmHg)

Nephropathy
› Ass with worsening of DR
› Renal transplantation may be ass with
improvement of DR and better response to
photocoagulation

Other
› Obesity, increased BMI, high waist-to-hip ratio
› Hyperlipidemia
› Anemia
Non-proliferative diabetic retinopathy
(NPDR)
 Mild NPDR
 Moderate NPDR
 Severe NPDR


Proliferative diabetic retinopathy (PDR)
 Macular
ischemia
› Retinal capillary non-perfusion
› Progressive NPDR
 Macular
edema
› Increased retinal vascular permeability
› Seen in both NPDR and PDR
› Focal or diffuse or mixed
› Cause of visual loss in DR
5% of DM pt.
 Finding

› Neovascularization : NVD, NVE
› Vitreous changes

Advanced diabetic eye disease
› Final stage of Uncontrolled PDR
› Glaucoma (neovascularization)
› Blindness from persistent vitreous
hemorrhage, tractional RD, opaque
membrane formation,
Focal macular edema
Diffuse macular edema
Macular ischemia
TIMELY MANAGEMENT
Pars plana vitrectomy (PPV)
 Membrane peeling (MP)
 Endolaser (EL)
 Fluid gas exchange (FGX)

› SF6
› C3F8
BEFORE & AFTER
BEFORE
AFTER
BEFORE
AFTER
Retinal abnormality
Follow up
Normal or rare microaneurysms
Once a year
Mild NPDR
q 9 months
Mod NPDR
q 6 months
Severe NPDR
q 4 months or laser
CSME
q 2-4 months ** or laser
PDR
q 2-3 months ** or laser
Ocular manifestations have been
reported in up to 70% of individuals
infected with HIV
Ocular manifestations almost
invariably reflect systemic disease and
may be the first sign of disseminated
systemic infection
The most common ocular finding is
HIV retinopathy, occurring in about
50%-70% of cases
Cytomegalovirus (CMV) - retinitis
Herpes Zoster - retinal necrosis
Toxoplasma gondii - retinochoroiditis
Mycobacterium tuberculosis - multifocal
choroiditis
Cryptococcus neoformans - multifocal
choroiditis
Pneumocystis carinii- choroiditis
Multifocal choroiditis is an alarming sign,
since it frequently represents
disseminated infection!
POSTERIOR SEGMENT COMPLICATIONS
Vasculitis (direct effect of the virus)
VIRUS INFECTIONS (MULTIPLE)
CMV retinitis
HSV acute retinal necrosis
MYCOTIC AND PARASITIC INFECTIONS
Pneumocystis carinii
 Multiple
sclerosis
 Stroke
 Intracranial
tumors
 Benign intracranial
hypertension
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
demyelination!
Decreased visual acuity
Afferent pupillary defect (if unilateral or
asymmetric)
Impairment of color vision
Pain with eye movements or pressure
on the globe
Central or ceco-central visual field
defect
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
A tumor close to the optic nerve,
chiasm or radiation may affect visual
acuity or visual field
Check both visual field and visual
acuity in patients with vague, but
persistent and progressive complaints
Headache is not always present!
Look for papilloedema or atrophy of
one or both optic nerve heads
Is caused by
impairment of axonic
flow in the optic nerve
Does not impair visual
acuity but increases
the size of the blind
spot
Optic atrophy implies
death of nerve fibers
and is associated with
impairment of visual
acuity, field or color
vision
Papilloedema
Raised intracranial pressure
No tumor
Syndrome found in plump young women
with persistent headache and menstrual
irregularities
Cause unknown
Therapy: diuretics
Long-term monitoring by a specialist
TIMELY REFERRAL OF PATIENTS
BOTH FROM
OPHTHALMOLOGISTS TO
CONCERNED SPECIALIST AND
VICE VERSA CAN BE CRITICAL
FOR SIGHT SAVING/LIFE SAVING