Abstract
The Appendix Ocular Emergencies contains tables of ocular complications of systemic disease, lifesaving ocular signs, ocular complications of systemic medications, differential diagnosis of the nontraumatic red eye, differential diagnosis of viral, bacterial and allergic conjunctivitis, and differential diagnosis of the red in contact lens wearers.
Keywords
allergic conjunctivitis, bacterial conjunctivitis, complications of systemic diseases, lifesaving ocular signs, nontraumatic red eyes, ocular complications, ocular emergencies, red eyes in contact lens wearers, treatments, viral conjunctivitis
| I. Ocular complications of systemic disease | |
|---|---|
| Disease | Possible ocular findings |
| Diabetes mellitus | Background retinopathy: retinal hemorrhages, exudates, and microaneurysms |
| Preproliferative retinopathy: cotton-wool spots, intraretinal microvascular abnormalities | |
| Proliferative retinopathy: neovascularization, preretinal hemorrhage, vitreous hemorrhage, retinal detachment | |
| Graves disease | Lid retraction, lid lag, exposure keratopathy, chemosis and injection, restriction of eye movements, proptosis, compressive optic neuropathy |
| Hypertension | Sclerosis of vessels in long-standing disease; narrowing of vessels, retinal hemorrhages and/or exudates in severe hypertension |
| Rheumatoid arthritis and other collagen vascular diseases | Dry eye, episcleritis, scleritis, peripheral corneal ulceration and/or melting |
| Cancer | Metastatic disease to choroid may result in retinal detachment; disease in the orbit can result in proptosis and restriction of eye movements (e.g., breast, lung cancer) |
| Sarcoidosis | Dry eye, conjunctival granulomas, iritis, retinitis |
| AIDS | Kaposi sarcoma, cotton-wool spots of retina, cytomegalovirus retinitis |
| II. Life-threatening ocular signs | |
|---|---|
| Findings | Clinical significance |
| White pupil | In an infant, retinoblastoma must be ruled out |
| Aniridia (iris appears absent) | May be autosomal dominant (2/3 s) or sporadic inheritance; in sporadic cases where the short arm of chromosome 11 is deleted, there is a 90% risk of developing Wilms’ tumor; the risk in other sporadic cases is approximately 20% |
| Thickened corneal nerves (slit lamp) | Part of the multiple endocrine neoplasia syndrome type IIB; must rule out medullary carcinoma of the thyroid; pheochromocytoma and parathyroid adenomas |
| Retinal angioma | May be part of von Hippel-Lindau syndrome; autosomal dominant inheritance with variable penetrance; must rule out hemangioblastomas of the central nervous system, renal cell carcinoma, and pheochromocytoma |
| Multiple pigmented patches of fundus | Lesions represent patches of congenital hypertrophy of the retinal pigment epithelium; may be part of Gardner’s syndrome, characterized by multiple premalignant intestinal polyps together with benign soft tissue tumors (lipomas, fibromas, sebaceous cysts) and osteomas of the skull and jaw; a complete gastrointestinal investigation is indicated; if a diagnosis of Gardner’s syndrome is made, prophylactic colectomy is indicated because of the potential for malignant degeneration of colonic polyps |
| Third-nerve palsy with a dilated pupil | Must rule out an intracranial aneurysm or neoplastic lesion; CT scan and/or MRI should be performed on an emergency basis |
| Papilledema | Must rule out an intracranial mass lesion; CT scan and/or MRI should be performed on an emergency basis |
| Pigmentary degeneration of the retina and motility disturbance | May represent the Kearns-Sayre syndrome; must rule out a cardiac condition disturbance with an annual electrocardiogram; may develop an intraventricular conduction defect, bundle block, bifascicular disease, or complete heart block; patient must be prepared for the possible need to implant a pacemaker |
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