Page 922 - TNFlipTest

OP32 Ophthalmology
Ocular Manifestations of Systemic Disease
Toronto Notes 2019
To Find Small Ocular Melanoma
TFSOM
T – Thickness >2 mm
F – Subretinal Fluid
S – Symptoms – vision changes
O – Orange pigment
M – Margin within 3 mm of optic disc
Treatment
• incisionalorexcisionalbiopsies
• mayrequirecryotherapy,radiotherapy,chemotherapy,immunotherapy • surgicalreconstruction
Uveal Melanoma
• mostcommon1°intraocularmalignancyinadults • moreprevalentinCaucasians
• arisefromuvealtract,90%choroidalmelanoma
• hepaticmetastasespredominate
Clinical Features
• classicappearanceofapigmenteddome-shapedmassextendingfromtheciliarybodyorthechoroid • diagnosisnecessitatesexpertiseofanophthalmologist/ocularoncologist
Treatment
• imagingtoinvestigatespread
• dependingonthesizeofthetumour,eitherradiotherapy,enucleation,limitedsurgery
Metastases
• mostcommonintraocularmalignancyinadults
• mostcommonlyfrombreastandlunginadults,neuroblastomainchildren
• usuallyinfiltratethechoroid,butmayalsoaffecttheopticnerveorextraocularmuscles • maypresentwithdecreasedordistortedvision,irregularlyshapedpupil,iritis,hyphema
Treatment
• localradiation,chemotherapy • enucleationifblind,painfuleye
Ocular Manifestations of Systemic Disease
HIV/AIDS
• upto75%ofpatientswithAIDShaveocularmanifestations
External Ocular Signs
• Kaposi’ssarcoma
■ secondary to human herpes virus 8 (HHV-8), affects conjunctiva of lid or the globe ■ differential diagnosis: subconjunctival hemorrhage (non-clearing), hemangioma
• multiplemolluscumcontagiosum • herpessimplex/zosterkeratitis
Retina
• HIVretinopathy(mostcommon)
■ cotton wool spots in >50% of HIV patients ■ intraretinal hemorrhage
• CMVretinitis
■ ocular opportunistic infection that develops when severely immunocompromised (CD4 count ≤50) ■ a necrotizing retinitis, with retinal hemorrhage and vasculitis, “brushfire” or “pizza pie” appearance ■ presents with scotomas (macular involvement and RD), blurred vision, and floaters
■ untreated infection will progress to other eye in 4-6 wk
■ treatment: virostatic agents (e.g. ganciclovir or foscarnet) via IV or intravitreal injection
• necrotizingretinitis
■ from herpes simplex virus, herpes zoster, toxoplasmosis
■ disseminated choroiditis
■ Pneumocystis carinii, Mycobacterium avium intracellulare, Candida
Other Systemic Infections
• herpeszoster
■ see Herpes Zoster, OP32 • candidalendophthalmitis
■ fluffy, white-yellow, superficial retinal infiltrate that may eventually result in vitritis ■ may present with inflammation of the anterior chamber
■ treatment: systemic amphotericin B, oral fluconazole