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Toronto Notes 2019 Ocular Manifestations of Systemic Disease TIA/Amaurosis Fugax
• sudden,transientblindnessfromintermittentvascularcompromise
• ipsilateralcarotidmostfrequentembolicsource
• typicallymonocular,lasting<5-10min
• Hollenhorstplaques(glisteningmicroemboliseenatbranchpointsofretinalarterioles)
Graves’ Disease
• ophthalmopathyoccursdespitecontrolofthyroidglandstatus
• ocularmanifestationsoccursecondarytosympatheticoverdriveand/orspecificinflammatoryinfiltrate
of the orbital tissue
Clinical
• initialinflammatoryphaseisfollowedbyaquiescentcicatricialphase
Treatment
• treathyperthyroidism
• monitorforcornealexposureandmaintaincornealhydration
• managediplopia,proptosis,andcompressiveopticneuropathywithoneoracombinationof:
■ steroids (during acute phase)
■ orbital bony decompression
■ external beam radiation of the orbit
• considerstrabismusand/oreyelidsurgicalproceduresonceacutephasesubsides
Connective Tissue Disorders
• RA,juvenileidiopathicarthritis,SLE,Sjögren’ssyndrome,ankylosingspondylitis,polyarteritisnodosa • mostcommonocularmanifestation:dryeyes(keratoconjunctivitissicca)
Giant Cell Arteritis/Temporal Arteritis
• seeRheumatology,RH20
Clinical Features
• morecommoninwomen>60yr
• abruptmonocularlossofvision,painoverthetemporalartery,jawclaudication,scalptenderness,
constitutional symptoms, and past medical history of polymyalgia rheumatica
• ischemicopticatrophy
• 50%losevisioninothereyeifuntreated
Diagnosis
• temporalarterybiopsy+increasedESR(ESRcanbenormal,butlikely80-100infirsthour),increased CRP
• ifbiopsyofonesideisnegative,biopsytheotherside
Treatment
• highdosecorticosteroidtorelievepainandpreventfurtherischemicepisodes
• ifdiagnosisofGCAissuspectedclinically:starttreatment+performtemporalarterybiopsytoconfirm
diagnosis within 2 wk of initial presentation (DO NOT WAIT TO TREAT)
Sarcoidosis
Definition
• granulomatousuveitiswithlarge“muttonfat”keratiticprecipitatesandposteriorsynechiae
• complicationsincludeglaucoma,cataracts,retinalhemorrhages,peripheralretinaneovascularization,
and dry eye
• neurosarcoidosis:opticneuropathy,oculomotorabnormalities,visualfieldloss
Treatment
• topical/systemicsteroidsandmydriatics
Ophthalmology OP35
The most common cause of unilateral or bilateral proptosis in adults is Graves’ disease
Progression of Signs and Symptoms of Graves’ Ophthalmopathy
NO SPECS
No signs/symptoms
Only signs (lid retraction, lid lag)
Soft tissue swelling (periorbital edema) Proptosis (exophthalmos)
Extraocular muscle weakness (causing diplopia)
Corneal exposure
Sight loss
ESR in Temporal Arteritis
Males >age/2
Females >(age + 10)/2
Does this Patient have Temporal Arteritis?
JAMA 2002;287:92-101
Rule in: jaw claudication and diplopia on history, temporal artery beading, prominence of the artery and tenderness over the artery on exam.
Rule out: no temporal artery abnormalities on exam, normal ESR.