Anatomy of Retina..

OCULAR MANIFESTATIONS OF SLE. SLE is a chronic auto immune disease with multisystem involvement.SLE is multifactorial . Possible factors are genetic susceptibility, environmental factors and disturbances in both innate and adaptive immunity. Early detection and prompt referral to ophthalmologist can prevent permanent visual loss in some instances. OCULAR MANIFESTATIONS. SLE can affect any part of the eye and visual pathway.Eyelids ,orbit, lacrimal system , conjunctiva ,cornea ,sclera ,episclera ,retina , choroid ,uvea ,cataract ,glaucoma and cranial nerve are all involved. EXTERNAL EYE DISEASES : 1.EYELID DISEASE:Discoid lupus rash over the eyelids present as discrete raised scaly lesions. HPE shows hyperkeratotic epithelium with liquefactive degeneration of the basal layer and dense perivascular lymphocytic infiltration. ANA titre,ESR,C reactive protein,CBC,LFT,RFT Complement factors C3 &C4,anti phospholipid antibodies ,immunoglobulins,rheumatoid factor TSH,VDRL,GFR,24 hour urinary protein etc are the investigations necessary. 2.LACRIMAL SYSTEM DISEASE : Dry eye syndrome is the most common ocular presentation. 3.ORBITAL DISEASE. It can present as orbital mass,periorbital oedema ,orbital myositis,panniculitis,acute orbital ischemia and infarction. Clinical presentation can be ptosis,proptosis, orbital pain,limitation of extra ocular movements and enophthalmos. Treatment is by immunosupression. ANTERIOR EYE SEGMENT MANIFESTATIONS 4.CONJUNCTIVA : Chronic conjunctivitis is infrequent.Conjunctiva is inflammed in SLE associated keratitis and scleritis. Treatment NSAID or anti malarial therapy given. 5.CORNEAL DISEASE: Breakdown of corneal epithelium can cause recurrent corneal erosions.The inflammatory process in SLE causes PERIPHERAL ULCERATIVE KERATITIS. Treatment is with systemic corticosteroids and cytotoxic agent during acute phase of the disease and lubrication of corneal surface concommitantly.TOPICAL STEROIDS ARE NOT ADVOCATED AS THEY INHIBIT NEW COLLAGEN PRODUCTION AND THEREBY INCREASE THE RISK OF PERFORATION. 6.EPISCLERA : Episcleritis is benign inflammation of the episclera. 7.SCLERAL DISEASE : Scleritis is a painful and potentially sight threatening disorder.b ANTERIOR SCLERITIS presents as diffuse nodular or necrotising scleritis resulting in significant destruction and scleral thinning. Redness is caused by injection of deep episcleral vessels. POSTERIOR SCLERITIS :Affects the sclera posterior to the equator of the globe. presenting symptoms are pain and blurry vision caused by exudative retinal detachment papillitis and cystoid macular edema. Immunosupression is essential. 8.ANTERIOR UVEITIS Rare presentation.Prompt immunosuppressive therapy is considered. 9.CATARACT : Iatrogenic steroid use in SLE is associated with cataract formation. 10.GLAUCOMA : Open angle glaucoma and angle closure glaucoma are seen in SLE. POSTERIOR EYE SEGMENT MANIFESTATIONS 11.SLE RETINOPATHY. The earliest findings are small intra retinal hemorrhages and cotton wool spots,multiple areas of polygonal retinal whitening between the retinal arterioles and venules. Systemic therapy with steroids, Immunosupression ,laser therapy,intra vitreal anti-vascular endothelial growth factor agents (anti-VEGF) and vitrectomy are all treatments offered. 12.RETINAL VEIN OCCLUSION / RETINAL ARTERY OCCLUSION. Pathogenesis of vaso occlusive retinopathy is due to thrombosis associated with anti- phospholipid syndrome. 13.RETINAL VASCULITIS : This is a rare potentially blinding complication of SLE. 14 CHOROIDOPATHY : Choroidopathy with exudative retinal detachment is a rare ocular manifestation of SLE.It is manifested as multi focal serous detachments of the retinal pigment epithelium (RPE) and the neural retina ,with the transduction of the accumulated fluid through bruch's membrane and RPE affected by the choroidal ischemia and inflammation. The presenting feature is visual loss ,which depends on the extent of the macular involvement. 15. OPTIC NEURVE DISEASE: SLE can cause optic neuritis and ischemic optic neuropathy.The optic nerve damage is believed to be secondary to an occlusive vasculitis of the small arterioles of the nerve , which leads to demyelination and /or axonal necrosis. Signs of optic nerve disease. *Reduced visual acuity. *Impairment of color vision. *Diminished light brightness sensitivity. *Decreased contrast sensitivity. *Afferant pupillary defect. *Visual field defects. 16.CRANIAL NERVE INVOLVEMENT. Ocular motor nerve palsy can occur. MANY OCULAR COMPLICATIONS ARE PREVENTABLE,TREATABLE OR EVEN CURABLE.PROMPT TREATMENT WITH HIGH DOSE SYSTEMIC CORTICOSTEROIDS AND IMMUNOSUPPRESSIVE THERAPY ARE NECESSARY.

Male patient from Samastipur and IOL done in Nepal,aged 48 yrs.He had 6/9 in right unoperated eye.Left pseudophakic eye had only PL & PR. Please comment .

32 yrs male pt with severe loss of vision in lt eye..diagnosis and differentials

A 20 year old student diagnosed with chronic kidney disease 5 years ago suffers from hypertension. His medication include amlodipine, carvedilol and hydralazine.He came to hospital with a 4 day history of right eye pain and redness,describing a "popping sensation".There was no history of trauma or sudden visual loss.Blood pressure was 260/160 what is the diagnosis and management ??

Fundus photograph of a young male patient having no vision at all.Diagnosis and possible causes