Intraocular manifestations of systemic sarcoidosis.

The incidence of intraocular manifestations was studied in 159 patients with systemic sarcoidosis. Eighty-seven patients (54.7%) who presented ocular lesions suggestive of sarcoidosis as an initial manifestation were diagnosed after a systemic survey. Seventy-two patients (45.3%) had chest signs or symptoms and were referred to ophthalmic examination during a diagnostic survey. Of the 159 patients, 126 (79.2%) showed intraocular involvements at diagnosis. In these patients with ocular involvements, iritis was the most frequent lesion, being seen in 74.7%. Gonioscopic examinations revealed trabecular nodules and tent-like peripheral anterior synechia in 61.2 and 54.5% of the patients respectively. Retinal perivasculitis and spotty retinochoroidal exudates were seen in 67.3 and 53.9% of the patients respectively. The data indicated the presence of intraocular lesions in a significant number of patients with sarcoidosis. These findings emphasize that all patients with systemic sarcoidosis need a thorough eye examination. This ocular examination should include gonioscopy.     

Intraocular pressure following systemic administration of cannabinoids

Various cannabinoids have been tested for activity compared to delta 9-THC in reducing intraocular pressure after intravenous administration in rabbits at 0.1 mg or 1 mg/animal. Comparison of l-delta 9-, delta 8-, 11-OH-delta 9- and 11-OH- delta 8-THC indicates that minor configurational changes have only a small influence on activity with regard to induction of a fall in intraocular pressure, although 11-OH-delta 8-THC has increased activity. 8 alpha-OH-, 8 alpha-diOH- and 8 beta-diOH-delta 9-THC have little or no activity but 8 beta-OH-delta 9-THC is as active as delta 9-THC indicating that the hydroxyl group in the beta-position does not influence activity. Modification of the C5H11 alkyl side chain (3'-OH-delta 9-THC) reduced activity to 20% relative to delta 9-THC. Cannabidiol (CBD), cannabichromene, cannabigerol and olivetol had no activity, but 10-OH-CBD had some activity at 2 mg/animal. Cannabinol (CBN) had about half the activity of delta 9-THC and activity was reduced further with 1'-OH-CBN, indicating that side chain modification reduced activity. Neither delta 9-THC, nor cannabigerol, had any effect on intraocular pressure or total outflow facility in the rhesus monkey, suggesting species differences in ocular responses to cannabinoids. Further studies on modification of these compounds is warranted in order to further delineate the structure-activity relationships.     

Ocular manifestations of systemic infections

Awareness of atypical presentations and understanding the pathogenesis of uncommon systemic infections will make us better clinicians. Recent literature alerts the ophthalmologist to recent findings and treatment options regarding ocular manifestations of malaria, cysticercosis, histoplasmosis, mucormycosis, subacute sclerosing panencephalitis, and Acanthamoeba infection.     

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.     

Neuro-ophthalmic manifestations of systemic disease--hematology

The hematopoietic system is a complex mixture of circulating blood cells, plasma, and plasma proteins. Disorders of the hematologic system may result from excess or impaired production of blood cells, destruction of blood cells, or abnormal function of existing blood cells. The afferent and efferent visual systems may both be affected by blood cell disorders, and the specific manifestation is dependent upon which cell line is involved, the type of dysfunction, and the characteristics of the target tissue. This article reviews the ocular and neuro-ophthalmic manifestation of hematologic disorders.     

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.     

Neuroophthalmologic manifestations of systemic disease

Significant contributions on the neuroophthalmologic manifestations of systemic disease have been published in the past year. The first part of this paper is devoted to practical guidelines that may help in the diagnosis and the management of oculomotor disorders, especially in connection with systemic diseases; the second part is focused on specific entities. Including idiopathic intracranial hypertension and ophthalmoplegic migraine in this review might be debatable; however, although the cause of these conditions is still unclear, relevant findings suggest that they may be the consequence of other adjacent processes rather than the cause itself. We believe that the diagnosis of idiopathic intracranial hypertension as well as that of ophthalmoplegic migraine remains a challenging issue for the ophthalmologist and may easily be overlooked.     

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 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 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 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.