Eye in Systemic Disease (eBook)

Jack J. Kanski, Dafydd J. Thomas (Autoren)

eBook Download: PDF | EPUB

2014 | 2. Auflage
170 Seiten
Elsevier Science (Verlag)
978-1-4831-6436-6 (ISBN)

Infos

The Eye in Systemic Disease, Second Edition presents an overview of the relationship of the eye and medicine. The book details the systemic aspects of diseases. The topics discussed include various eye conditions such as conjunctivitis, episcleritis, keratitis, keratoconjunctivitis sicca, and cataract. Endocrine, circulatory, rheumatological, neurological, pulmonary, and blood disorders are covered as well. Physicians and students of medicine and pathology will find the book very useful.

Honorary Consultant Ophthalmic Surgeon, Prince Charles Eye Unit, King Edward VII Hospital, Windsor, Royaume-Uni

Inhalt

Front Cover 1
The Eye in Systemic Disease 4
Copyright Page 5
Table of Contents 8
Preface 6
Chapter 1. Introduction 10
Conjunctivitis 10
Episcleritis 10
Keratoconjunctivitis sicca 11
Keratitis 12
Scleritis 13
Anterior uveitis 13
Cataract 14
Posterior uveitis 15
Vascular disorders of the fundus 16
Chapter 2. Endocrine disorders 18
Thyroid dysfunction 18
Diabetes mellitus 27
Chapter 3. Circulatory disorders 35
Hypertension 35
Giant cell arteritis 38
Carotid artery disease 42
Chapter 4. Rheumatological disorders 48
Rheumatoid arthritis 48
Ankylosing spondylitis 50
Reiter's syndrome 52
Psoriatic arthritis 53
Juvenile chronic arthritis 54
Behçet's disease 56
Chapter 5. Connective tissue disorders 60
Systemic lupus erythematosus 60
Systemic sclerosis 61
Polymyositis and dermatomyositis 62
Polyarteritis nodosa 63
Chapter 6. Neurological disorders 65
Myasthenia gravis 65
Myasthenic (Eaton–Lambert) syndrome 66
Ocular myopathies 66
Dystrophia myotonica 67
Multiple sclerosis 68
Abnormalities of the pupil 71
Nystagmus 75
Third (oculomotor) nerve disease 76
Fourth (trochlear) nerve disease 81
Sixth (abducens) nerve disease 83
Disorders of the chiasm 86
Disorders of the optic tract 93
Disorders of the optic radiations and visual cortex 93
Raised intracranial pressure 96
Carotid-cavernous fistula 101
Migraine 102
Wilson's disease 105
Essential blepharospasm 106
Chapter 7. Pulmonary disorders 107
Sarcoidosis 107
Tuberculosis 111
Wegener's granulomatosis 113
Chapter 8. Gastrointestinal disorders 116
Crohn's disease 116
Ulcerative colitis 116
Whipple's disease 117
Familial polyposis coli 117
Chapter 9. Sexually transmitted diseases 119
Acquired immune deficiency syndrome 119
Acquired syphilis 121
Congenital syphilis 123
Chlamydial oculogenital infection 124
Gonorrhoea 125
Chapter 10. Skin disorders 126
Cicatricial pemphigoid 126
Stevens–Johnson syndrome (severe bullous erythema multiforme) 127
Pseudoxanthoma elasticum 129
Atopic eczema 130
Acne rosacea 131
Albinism 132
Chapter 11. Blood disorders 134
Anaemias 134
Leukaemias 135
Hyperviscosity syndromes 136
Sickle-cell disease 137
Chapter 12. Malignant diseases 139
Metastatic carcinoma 139
Multiple myeloma 140
Lymphomas 141
Chapter 13. Phacomatoses 144
Sturge-Weber syndrome 144
Neurofibromatoses 145
Tuberous sclerosis 147
Von Hippel–Lindau syndrome 149
Ataxia telangiectasia (Louis–Bar syndrome) 150
Wyburn-Mason syndrome 151
Chapter 14. Miscellaneous disorders 152
Systemic associations of ectopia lentis 152
Systemic associations of retinitis pigmentosa 155
Mucopolysaccharidoses 156
Retinopathy of prematurity 157
Chapter 15. Ocular toxicity from systemic drugs 160
Systemic steroids 160
Antimalarials 161
Amiodarone 163
Chlorpromazine 163
Thioridazine 164
Tamoxifen 164
Ethambutol 165
Index 166

Textauszug

1

Introduction

Publisher Summary

This chapter discusses the various eye conditions. Conjunctivitis is a very common—usually microbial—inflammation of the mucous membrane which lines the anterior sclera and the inside of the eyelids. Episcleritis is a common—non-microbial—inflammation of the vascular connective tissue layer, which is located between the conjunctiva and the sclera. It typically affects one eye of a healthy middle-aged female. Keratoconjunctivitis sicca is a common condition in which tear secretion by the lacrimal glands is reduced. Treatment is effective with frequent instillation of artificial tears. Keratitis is an inflammation of the cornea. The most common causes are herpes simplex, herpes zoster, bacteria and hypersensitivity to staphylococcal exotoxins. Corneal haziness and ulceration are the two most common signs. The treatment is with topical antimicrobial agents, and in selected cases, steroids may also be indicated. Anterior uveitis is an inflammation of the anterior part of the uveal tract which consists of the iris and ciliary body. The two main types are acute and chronic. The treatment includes topical steroids to suppress the inflammation and mydriatics to prevent the formation of adhesions between the iris and the lens.

The main aim of this chapter is to familiarize the non-ophthalmologist with the various eye conditions that will be described in this book.

Conjunctivitis

Conjunctivitis is a very common, usually microbial, inflammation of the mucous membrane which lines the anterior sclera and the inside of the eyelids.

Causes

The most common causes are bacteria, chlamydia, and viruses. Occasional systemic associations include:

• Reiter’s disease.

• Psoriatic arthritis.

• Wegener’s granulomatosis.

• Cicatricial pemphigoid.

• Stevens—Johnson syndrome.

• Gonorrhoea.

• Crohn’s disease.

Symptoms

Subacute onset of grittiness, usually bilateral, and a mucoid or serous discharge.

Signs

These include normal visual acuity, redness which is maximal in the lower fornices (Figure 1.1) and a variable amount of discharge.

Figure 1.1 Acute conjunctivitis with maximal injection in the lower fornix

Treatment

This is usually with topical antimicrobial agents.

Prognosis

This is excellent and, even without treatment, the vast majority resolve within 7—10 days.

Episcleritis

Episcleritis is a common non-microbial inflammation of the vascular connective tissue layer, which is located between the conjunctiva and the sclera. It typically affects one eye of a healthy middle-aged female.

Causes

Most cases are idiopathic and unassociated with any systemic disease.

Symptoms

These are acute or subacute onset of mild unilateral discomfort and redness.

Signs

A localized red patch involving either the medial or the lateral aspects of the eye (Figure 1.2).

Figure 1.2 Localized area of injection in episcleritis (courtesy of Mr A. Shun-Shin)

Treatment

Topical steroids may be helpful if started early.

Prognosis

This is excellent and most cases resolve within a few days but recurrences may occur.

Keratoconjunctivitis sicca

Keratoconjunctivitis sicca (KCS) is a common condition in which tear secretion by the lacrimal glands is reduced.

Causes

Pure KCS This is common and is characterized by involvement of the lacrimal gland alone.

Primary Sjögren’s syndrome This is an autoimmune disease characterized by the frequent presence of rheumatoid factor, antinuclear antibodies and hypergammaglobulinaemia. Less common findings include antibodies to DNA, salivary duct tissue, smooth muscle and gastric parietal cells. Involvement of the salivary glands may cause a dry mouth (xerostomia), and the bronchial epithelium and the vagina may also be affected.

Secondary Sjögren’s syndrome This is the presence of KCS in association with a systemic disorder such as:

• Rheumatoid arthritis.

• Psoriatic arthritis.

• Connective tissue disorder.

• Sarcoidosis.

• Crohn’s disease.

Symptoms

These are chronic ocular irritation and a foreign body sensation.

Signs

Slit lamp biomicroscopy shows an absent or diminished lower lid tear meniscus, mucous threads in the tear film and corneal filaments. Rose bengal is a dye which shows up mucous threads and corneal filaments more clearly (Figure 1.3), and also stains the bulbar conjunctiva in the form of two triangles with their bases at the limbus (Figure 1.4). The amount of tear secretion can also be determined by measuring the amount of moistening of a special strip of filter paper folded so that 5 mm of the strip lies within the conjunctival sac (Schirmer’s test). A value of less than 5 mm in 5 minutes is indicative of KCS and values between 5 and 10 mm are borderline.

Figure 1.3 Mucous threads and corneal filaments in keratoconjunctivitis sicca stained with rose bengal

Figure 1.4 Conjunctival staining with rose bengal in keratoconjunctivitis sicca

Treatment

Frequent instillation of artificial tears (e.g. hypromellose) is effective in most patients.

Prognosis

This is excellent although treatment may have to be continued indefinitely.

Keratitis

Keratitis is an inflammation of the cornea.

Causes

The most common causes are herpes simplex, herpes zoster, bacteria and hypersensitivity to staphylococcal exotoxins. Occasional systemic associations include:

• Rheumatoid arthritis.

• Connective tissue disorders

• Wegener’s granulomatosis.

• Crohn’s disease.

• Acne rosacea.

• Atopic eczema.

• Syphilis.

Symptoms

These are variable blurring of vision, watering, pain and photophobia.

Signs

Corneal haziness and ulceration are the two most common signs (Figure 1.5).

Figure 1.5 Severe bacterial keratitis with hypopyon

Treatment

Treatment is with topical antimicrobial agents and, in selected cases, steroids may also be indicated.

Prognosis

This is usually good provided treatment is started early.

Scleritis

Scleritis is a very rare inflammation of the tough white outer collagenous layer of the eye.

Causes

The most common local cause is herpes zoster. The most frequent systemic associations include:

• Rheumatoid arthritis.

• Connective tissue disorders.

• Wegener’s granulomatosis.

Symptoms and signs

For these see Chapter 4.

Treatment

Treatment is with systemic non-steroidal anti-inflammatory agents in mild cases, and steroids and/or cytotoxic agents in severe cases.

Prognosis

Many cases develop complications such as keratitis, cataract and glaucoma.

Anterior uveitis

Anterior uveitis (iridocyclitis) is an inflammation of the anterior part of the uveal tract which consists of the iris and ciliary body. The two main types are acute and chronic.

Acute anterior uveitis

Causes

Many cases are idiopathic. Systemic associations include:

• Ankylosing spondylitis.

• Reiter’s...

Produkt-Details

• Erscheint lt. Verlag: 3.4.2014
• Sprache: englisch
• Themenwelt: Sachbuch/Ratgeber ► Gesundheit / Leben / Psychologie ► Krankheiten / Heilverfahren
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Augenheilkunde
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Pharmakologie / Pharmakotherapie
• Themenwelt: Studium ► 1. Studienabschnitt (Vorklinik) ► Physiologie
• Themenwelt: Naturwissenschaften ► Biologie ► Humanbiologie
• ISBN-10: 1-4831-6436-5 / 1483164365
• ISBN-13: 978-1-4831-6436-6 / 9781483164366