Ocular manifestation of systemic disease: RA, SLE

Question 1

Ocular conditions seen in RA

Answer 1

1. Keratoconjunctivitis Sicca (Dryness of conjunctiva)
2. Peripheral ulcerative keratitis (inflammation causes cornea to melt away)
   - A/w corneal thinning
3. Scleritis
4. Episcleritis

Question 2

Treatment for ocular conditions in RA

Answer 2

Systemic treatment:
Diagnosis and treatment of systemic disease
Steroids
DMARDS

Ocular treatment:
Lubricants
Steroid eyedrops (reduce melt and inflammation )
Transplant grafts (long term immunosuppression)

Question 3

Ocular manifestations seen in SLE

Answer 3

Eyelid erythema
Discoid lesion
Keratoconjunctivitis sicca
Keratitis with peripheral corneal thinning
Scleritis
Retinopathy (Cotton wool spot ± hemorrhage)
Neuro-ophthalmic Cx

Question 4

Commonest vision-threatening infection in AIDS

Answer 4

Cytomegalovirus retinitis

Question 5

S&S of CMV retinitis

Answer 5

Initially asymptomatic
Immunocompromised patient
Presentation:
- Floaters
- Painless loss of central or peripheral vision

Signs
- Starts with the peripherals
- Cheese (retinitis) and Ketchup (hemorrhage) appearance
- Retinitis usually starts at midperiphery and progresses in a brush fire pattern, producing areas of necrosis, scarring and atrophy

Poor prognosis for vision, can lead to loss of macular function

Question 6

Management for CMV retinitis

Answer 6

Manage concurrently with ID
IV - Ganciclovir, foscarnet or cidofovir
Intravitreal - Ganciclovir / foscarnet
Implants - Ganciclovir
Oral - Valganciclovir (Expensive but effective)