Systemic signs




FACE


Facial rash


Atopic eczema


Signs





  • Dry, itchy, erythematous thickening of facial skin ( Fig. 15.1 ).




    Fig. 15.1



Look for





  • Staphylococcal blepharitis.



  • Vernal and atopic keratoconjunctivitis.



  • Early-onset shield-like cataract.



  • Keratoconus.



  • Retinal detachment.



Acne rosacea


Signs





  • Erythema and papules on the glabella, cheeks, nose and chin ( Fig. 15.2 ).




    Fig. 15.2



Look for





  • Chronic posterior blepharitis.



  • Recurrent chalazion.



  • Peripheral keratitis.



Sarcoidosis (lupus pernio)


Signs





  • Violaceous lesions with a predilection for the nose ( Fig. 15.3 ).




    Fig. 15.3



Look for





  • Uveitis.



  • Retinal periphlebitis.



  • Fundus granulomas.



  • Dry eye.



  • Conjunctival granulomas.



Systemic lupus erythematosus


Signs





  • Erythematous rash involving the cheeks and bridge of the nose with a ‘butterfly’ distribution ( Fig. 15.4 ).




    Fig. 15.4



Look for





  • Dry eye.



  • Peripheral ulcerative keratitis.



  • Scleritis.



  • Retinopathy.



Dermatomyositis


Signs





  • Extensive erythematous rash ( Fig. 15.5 ).




    Fig. 15.5



Look for





  • Violaceous (heliotrope) eyelid rash and periorbital oedema.



  • Dry eye.



  • Scleritis.



  • Retinopathy.



Tuberous sclerosis (adenoma sebaceum)


Signs





  • Red papules on the cheeks and nose ( Fig. 15.6 ).




    Fig. 15.6



Look for





  • Fundus astrocytomas.



Xeroderma pigmentosum


Signs





  • Bird-like facies, and cutaneous atrophy, scaling and pigmentation with a propensity to malignant change ( Fig. 15.7 ).




    Fig. 15.7



Look for





  • Eyelid and conjunctival malignancies.



  • Dry eye.



Facial pigmentary changes


Port wine stain (naevus flammeus)


Signs





  • Sharply demarcated, usually unilateral, soft, purple patch which occurs in patients with Sturge–Weber syndrome ( Fig. 15.8 ).




    Fig. 15.8



Look for





  • Episcleral haemangioma.



  • Diffuse choroidal haemangioma.



  • Glaucoma.



  • Heterochromia iridis.



Naevus of Ota (oculodermal melanocytosis)


Signs





  • Unilateral hyperpigmentation of deep facial skin, most frequently in the distribution of the 1st and 2nd divisions of the trigeminal nerve ( Fig. 15.9 ).




    Fig. 15.9



Look for





  • Episcleral hyperpigmentation.



  • Heterochromia iridis.



  • Iris mammillations.



  • Trabecular hyperpigmentation and glaucoma.



  • Fundus hyperpigmentation.



  • Uveal melanoma.



Lack of facial expression


Myotonic dystrophy


Signs





  • Bilateral facial wasting with hollow cheeks, sagging jaw and ptosis ( Fig. 15.10 ).




    Fig. 15.10



Look for





  • Early-onset shield-like cataract.



  • Light-near dissociation of pupils.



  • Mild pigmentary retinopathy.



Myasthenia gravis


Signs





  • Myasthenic involvement of muscles of facial expression and ptosis ( Fig. 15.11 ).




    Fig. 15.11



Look for





  • Ophthalmoplegia, particularly involving elevation.



Systemic sclerosis


Signs





  • Shiny tight facial skin due to subcutaneous fibrotic changes, nasal deformity and vertical furrowing of perioral skin ( Fig. 15.12 ).




    Fig. 15.12



Look for





  • Eyelid scarring.



  • Dry eye.



  • Retinopathy.



Parkinsonism


Signs





  • Sweaty and greasy face with mild lid retraction ( Fig. 15.13 ).




    Fig. 15.13



Meretoja syndrome


Signs





  • Bilateral facial palsy ( Fig. 15.14 ).




    Fig. 15.14



Look for





  • Corneal lattice dystrophy type 2.



Möbius syndrome


Signs





  • Bilateral facial paresis with the mouth constantly held open ( Fig. 15.15 ).




    Fig. 15.15



Look for





  • Esotropia.



  • Limitation of abduction.



  • Horizontal gaze palsy.



Facial spasm


Essential blepharospasm


Signs





  • Periodic bilateral involuntary spasm of the orbicularis oculi and upper facial muscles temporally rendering the patients functionally blind ( Fig. 15.16 ).




    Fig. 15.16



Facial hemispasm


Signs





  • Brief unilateral spasm of the orbicularis oculi and facial muscles ( Fig. 15.17 ).




    Fig. 15.17



Facial hirsutism


Cushing syndrome


Signs





  • Also moon face and hyperpigmentation ( Fig. 15.18 )




    Fig. 15.18



Look for





  • Bitemporal hemianopia due to adenoma (Cushing disease).



  • Cataract.



Acromegaly


Signs





Look for





  • Bitemporal hemianopia due to a pituitary adenoma.



  • Optic atrophy.



  • Angioid streaks.



Turner syndrome


Signs





Look for





  • Keratoconus.



  • Blue sclera.



  • Cataract.



Porphyria cutanea tarda


Signs





  • Bullous skin eruptions and scarring ( Fig. 15.21 ).




    Fig. 15.21



Look for





  • Cicatrising conjunctivitis.



  • Scleritis.



Fair complexion and blond hair


Oculocutaneous albinism


Signs





  • Pale skin and blond hair ( Fig. 15.22 ).




    Fig. 15.22



Look for





  • Nystagmus.



  • Iris transillumination.



  • Pale fundus and foveal hypoplasia.



  • Anomalous chiasmal nerve fibre pathway.



Homocystinuria


Signs





  • Coarse fair hair and malar flush (see Fig. 10.16 ).



Look for





  • Ectopia lentis.



  • Myopia.



  • Retinal detachment.



Saddle-shaped nose


Congenital syphilis


Pathogenesis





  • Osteitis of the nasal bone ( Fig. 15.23 ).




    Fig. 15.23



Look for





  • Interstitial keratitis.



  • Pigmentary retinopathy.



Wegener granulomatosis


Pathogenesis





  • Necrotising granulomatous vasculitis involving the nose ( Fig. 15.24 ).




    Fig. 15.24



Look for





  • Scleritis.



  • Peripheral ulcerative keratitis.



  • Orbital involvement.



  • Nasolacrimal duct obstruction.



  • Retinopathy.



Relapsing polychondritis


Pathogenesis





  • Recurrent inflammatory swelling, destruction and collapse of nasal cartilage ( Fig. 15.25 ).




    Fig. 15.25



Look for





  • Scleritis.



  • Anterior uveitis.



Leprosy


Pathogenesis





  • Destruction of the nasal bone and cartilage ( Fig. 15.26 ).




    Fig. 15.26



Look for





  • Madarosis.



  • Anterior uveitis.



  • Miosis.



  • Iris atrophy.



  • Keratitis.



  • Scleritis.





MOUTH


Ulceration


Behçet disease


Signs





  • Recurrent, painful aphthous stomatitis which may involve the buccal mucosa and the tongue ( Fig. 15.27 ).




    Fig. 15.27



Look for





  • Anterior uveitis with hypopyon.



  • Panuveitis.



  • Retinal vasculitis.



Reiter syndrome


Signs





  • Transient painless ulceration ( Fig. 15.28 ).




    Fig. 15.28



Look for





  • Conjunctivitis.



  • Acute anterior uveitis.



  • Keratitis.



Stevens–Johnson syndrome


Signs





  • Mucosal bullae and erosions associated with haemorrhagic crusting of the lips ( Fig. 15.29 ).




    Fig. 15.29



Look for





  • Cicatrising conjunctivitis.



Mucous membrane pemphigoid


Signs





  • Mucosal blisters and superficial erosions ( Fig. 15.30 ).




    Fig. 15.30



Look for





  • Cicatrising conjunctivitis.



Pemphigus vulgaris


Signs





  • Mucosal blisters and erosions ( Fig. 15.31 ).




    Fig. 15.31



Look for





  • Cicatrising conjunctivitis.



Secondary syphilis


Signs



Jun 6, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on Systemic signs

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