Ocular manifestations of systemic infections

Ocular involvement, mainly uveitis or retinochoroiditis, is common in various systemic diseases, such as endogenous endophthalmitis, Lyme disease, human T-cell lymphotropic virus type I infection, toxoplasmosis, and toxocariasis. Recent progress, especially in laboratory microbiologic testing, has enabled us to reliably diagnose many formerly idiopathic intraocular inflammatory diseases. A group of systemic infectious diseases, including those discussed here, are implicated as a body of emerging or re-emerging diseases that have appeared in the past two decades and are thought to have a close relation with global socioenvironmental changes. This paper discusses recent clinical and experimental studies of the most important systemic infectious diseases that affect the eye.     

Ocular manifestations of systemic infections.

Systemic infections occasionally present with ocular involvement. Prompt diagnosis and management, aided by an internist, may lead to resolution of the infection without severe ocular sequelae. Recent literature discussing atypical ophthalmic manifestations, treatment options, or transmission risks of the following diseases is reviewed: infection with hepatitis viruses, toxoplasmosis, tuberculosis, bacteremia, and endogenous mycotic endophthalmitis.     

Ocular manifestations of systemic malignancies

Ocular manifestations of systemic malignancy are important for both the ophthalmologist and the internist to recognize because they may precede the diagnosis of cancer. This review of the current literature discusses the clinical manifestations, etiology, and potential therapeutic interventions for a group of visual paraneoplastic syndromes, including carcinoma-associated retinopathy and melanoma-associated retinopathy. These conditions are characterized by elevated serum levels of autoantibodies directed against tumor antigen that cross-react with retinal proteins, resulting in rod and cone dysfunction. The clinical presentation, site of origin, frequency, and intraocular distribution of tumors metastatic to the eye are also reviewed.     

Ocular manifestations of systemic infection

Increased research and awareness of various systemic infections places a greater emphasis on the ophthalmologist's knowledge of ocular manifestations of these diseases. New advances in the diagnosis and treatment, as well as studies of the pathogenesis and histological features of different infectious processes are continually being reported. Recent publications focusing on ophthalmic findings of infectious diseases are reviewed. This article discusses new reports on herpes simplex, herpes zoster, Lyme disease, malaria, onchocerciasis, cysticercosis, and toxocariasis.     

Ocular manifestations of various systemic diseases

Transsphenoidal encephalocele is associated with tongue-shaped retinochoroidal coloboma and optic disc dysplasia. Non-Graves' orbital polymyositis is associated with giant cell myocarditis. Ocular embolic disease can result from papillary fibroelastoma of the heart. Cutaneous melanoma can metastasize to the eye in the form of intraocular pigment without a discrete mass leading to heterochromia, glaucoma, and visual loss. Patients with atopic dermatitis are prone to develop retinal detachment similar in configuration to traumatic retinal detachment. The retinal hamartomas in tuberous sclerosis are usually stable, but occasionally the hamartomas show new or increased calcification, and rarely new lesions appear de novo.     

Ocular manifestations of systemic hypertension.

Recent population-based studies suggest that the fundus lesions of hypertension also occur in people without hypertension. In experimental studies, hypertensive lesions, which used to be the backbone of older classifications of the severity of hypertension, did not correlate sufficiently with severity to allow reliable grading. Hypertensive retinopathy, choroidopathy, and optic neuropathy are independent processes. Vascular narrowing appears to occur early in the disease process, whereas retinal hemorrhages and retinal lipid may occur later. Branch vein occlusion is a complication of hypertension, whereas open-angle glaucoma may not be. Choroidal neovascularization in the fellow eyes of patients with macular degeneration is associated with high blood pressure. Laser treatment for this disorder is less effective in patients with high blood pressure than it is in normotensive individuals, which suggests that choroidal neovascularization may be an expression of chronic hypertensive choroidopathy. Hypertensive optic neuropathy, a variant of ischemic optic neuropathy, has delayed onset compared with retinopathy and, in experimental studies, has not been linked to the severity of hypertension. Given these findings, it may be better to describe than to grade fundus lesions. In either event, it is important to take blood pressures accurately. Fundus lesions suggest high blood pressure. Sphygmomanometry is more specific and reliable than funduscopy in making that diagnosis.     

Ocular manifestations of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic, immunologic disorder that may affect multiple organ systems. Keratoconjunctivitis sicca is the most common ocular manifestation, but visual morbidity is usually due to retinal and neuro-ophthalmic manifestations of the disease. Ocular manifestations of lupus are a reflection of systemic disease. The presence of ocular manifestations should alert the clinician to the likely presence of disease activity elsewhere. Therefore, all patients with ocular lupus should be carefully evaluated for systemic involvement to detect potentially treatable and preventable complications of the disease. In addition, the ophthalmologist should include SLE in the differential diagnosis of many retinal vascular and neuro-ophthalmic disorders. The ophthalmologist may play an important role in the care of patients with SLE, since ocular inflammatory lesions may precede potentially serious extraocular disease.     

Ocular manifestations of systemic diseases.

The purpose of this review is to keep the optometrist informed as to the latest developments in the field of Ophthalmology. Papers reviewed are, almost exclusively, those published between Oct. 1st, 1973 and Sept. 30th, 1974. Emphasis will be placed on signs and symptoms of the disorders which are helpful in their detection or confirmation. No rare disorders will be discussed and although the literature has been especially rich in single cases this past year, they have been, for the most part, omitted from this review. Thus, to an ophthalmologist, the selection may appear arbitrary and incomplete. For purposes of reviewing, as in previous years, diseases reviewed are divided into non infectious and infectious. Infectious diseases are grouped according to the organ system or the system function predominantly affected, including hereditary and/or congenital diseases. The infectious diseases are grouped as to the causative pathogenic organism.     

Ocular manifestations of various systemic disorders

Diode laser photoablation of the retinal periphery is an effective treatment for zone 1 or 2 threshold retinopathy of prematurity. Patients with small cell carcinoma of the lung and cancer-associated retinopathy have immunoreactivity with the 23-kD retinal cancer-associated antigen and a similar antigen is secreted by in vitro propagated cultures of small cell carcinoma of the lung. This cancer-associated autoimmune retinopathy is characterized by rapid visual loss, night blindness, color loss, and reduced electroretinograms. Angioid streaks start as narrow, short discontinuous hypopigmented streaks that enlarge and widen with the end stage being disciform macular degeneration, helicoid peripapillary atrophy, or diffuse choroidal sclerosis. In the setting of neonatal cholestasis, the findings of microcornea, posterior embryotoxon, mosaic iris stromal hypoplasia, anomalous optic discs, and regional peripapillary retinal depigmentation suggest the diagnosis of Alagille syndrome (arteriohepatic dysplasia).     

Ocular manifestations of various systemic diseases

Diode laser therapy for retinopathy of prematurity appears superior to cryotherapy, because cryotherapy induces high myopia and macular coloboma-like changes. Plaque radiotherapy is highly effective in inducing regression of isolated uveal metastasis whether used as a primary therapy or when other modalities have failed. The nevus sebaceous syndrome is characterized by a yellowish discoloration of the posterior pole from intrascleral deposits of cartilage. Ultrasonic evidence of optic disc drusen helps in the diagnosis of Alagille syndrome in infants with intrahepatic cholestasis.     

Ocular manifestations of various systemic diseases

Renal failure in association with uveitis should raise the possibility of sarcoidosis even with a normal chest radiograph. Diode laser photocoagulation using the indirect ophthalmoscope delivery system is shown to be safe in the therapy of eyes with threshold retinopathy of prematurity and especially in eyes with tunica vasculosa lentis and is safer than argon laser, which is known to cause cataract formation. Eyes with retinopathy of prematurity stage 5 remain with a flat electroretinogram despite surgical reattachment, implying the existence of a severe irreversible dysfunction in these retinas. Choroidal metastases from prostate carcinoma can resolve after total androgen deprivation. Optic nerve metastases respond poorly to the radiation dose usually given for choroidal metastases and therefore require a higher dosage of radiation.     

Ocular manifestation of systemic infections

Patients with various systemic infections can often be diagnosed on the basis of their presenting ocular signs and symptoms. Recognition of the ocular manifestations of systemic infections will expedite diagnosis and allow rapid institution of appropriate therapy thereby reducing morbidity and mortality. Recent literature discussing ophthalmologic findings in the following diseases are reviewed: Whipple's disease, endogenous endophthalmitis, cat-scratch disease, toxoplasmosis, and hepatitis C.     

Ocular manifestation of systemic infections

Careful examination of external and internal ocular structures in patients with systemic infections may assist in early diagnosis and institution of appropriate therapy. Recent literature discussing ocular manifestations in the following systemic infectious diseases are reviewed: tuberculosis, Lyme borreliosis, cat scratch disease, toxocariasis, congenital toxoplasmosis, and invasive aspergillosis.     

Ocular manifestations and concepts of systemic vasculitides

Vasculitic disorders are relatively rare. Their etiology and pathophysiology remain enigmatic, leading to confusing nomenclature and multiple classification schemes. Untreated vasculitis can be fatal. Early diagnosis is the key to successful treatment and better prognosis. However, early diagnosis can be difficult; vasculitic conditions usually present with non-specific symptoms for a long period before clinically overt manifestations occur. Ophthalmologists should be familiar with the ocular manifestations of the vasculitic disorders because they may not only be sight-threatening, but more importantly could be the presenting manifestations of active, potentially lethal systemic disease. This review summarizes clinical and ocular manifestations of systemic vasculitic disorders. Furthermore, it discusses general concepts in diagnosis and treatment of these diseases in an effort to provide a practical framework for the ophthalmologist evaluating patients with vasculitis.