Ocular manifestations of systemic diseases

[wondertwinkle]

I spent a few weeks in a rheumatology clinic on certain days during my third year medicine rotation. It amazed me to see how many ocular manifestations there are in these conditions. For residents / attendings, are there other general areas of medicine that also have a high degree of ocular manifestations? Just curious... because it would be helpful to pay attention to these areas during the rest of medical school Thanks!!

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[FutureCTDoc]

I spent a few weeks in a rheumatology clinic on certain days during my third year medicine rotation. It amazed me to see how many ocular manifestations there are in these conditions. For residents / attendings, are there other general areas of medicine that also have a high degree of ocular manifestations? Just curious... because it would be helpful to pay attention to these areas during the rest of medical school Thanks!!

Diabetes shows up in the eye, there can be ocular involvement of MS. A PT presented to my father's office with cotton wool spots and a CC of vision change, he was having a hypertensive crisis. Tumors pressing on the optic nerve and melanoma can present in the eye. Herpes can affect the eye. Although rare I've seen vision damage to drug toxicity from amiodarone and ethambutol, which while not systemic diseases, they were indicative of drug toxicity. Opportunistic infections of HIV can present in the eye as well.

 

[DKofLV]

Diabetes shows up in the eye, there can be ocular involvement of MS. A PT presented to my father's office with cotton wool spots and a CC of vision change, he was having a hypertensive crisis. Tumors pressing on the optic nerve and melanoma can present in the eye. Herpes can affect the eye. Although rare I've seen vision damage to drug toxicity from amiodarone and ethambutol, which while not systemic diseases, they were indicative of drug toxicity. Opportunistic infections of HIV can present in the eye as well.

Very impressive for a pre-med...I really am impressed

Gaucher's, Hurlers, Hunters, Sly, Morquio disease can have corneal and/or retinal diseases

Zoster and HSV can cause injury/problems with almost every level

Wilms tumor is certainly associated with sporadic aniridia

Osteogenesis imperfecta

Diabetes, HTN...HIV...

Plenty of meds can cause ocular side effects from the chloroquine/plaquenil type of maculopathy to amiodarone verticillata to topiramate induced angle closure glaucoma

Sarcoid, RA, Lupus, Lyme, Syphilis, Behcet's disease all certainly can affect the eye...

I could keep going...

but I guess in short (as you can see)...almost ANY disease in some form can possibly have ocular manifestations...certainly this does not apply to 100% of diseases...but a shockingly large amount

 

[PBEA]

no "pre-med" knows what a CWS is. I think he's lying about his status.

Fess up CTdoc.

 

[DOCTORSAIB]

no "pre-med" knows what a CWS is. I think he's lying about his status.

Fess up CTdoc.

I was "pre-med" at one time and yet a fully-trained ophthalmic tech working in an academic ophthalmology dept for > 2 years. I definitely knew what a CWS was and what it looked like.

You're making an assumption.

 

[bungo]

no "pre-med" knows what a CWS is. I think he's lying about his status.

Fess up CTdoc.

Most pre-meds and all medical students know what cotton wool spots are.

 

[FutureCTDoc]

no "pre-med" knows what a CWS is. I think he's lying about his status.

Fess up CTdoc.

I certainly wish I was lying so I wouldn't have to take orgo. My father is a retinal surgeon and I've spent about 300 hours in the office and viewed about 200 surgeries, 50% cataract, 45% retinal (mainly vitrectomy) and 5% other (mostly glaucoma). I must say I do like the the fact that you think so highly of me though.

 

[PBEA]

I certainly wish I was lying so I wouldn't have to take orgo. My father is a retinal surgeon and I've spent about 300 hours in the office and viewed about 200 surgeries, 50% cataract, 45% retinal (mainly vitrectomy) and 5% other (mostly glaucoma). I must say I do like the the fact that you think so highly of me though.

I stand corrected, you have had a very unique experience. CWS is not something you would typically find in an undergrad curriculum.

 

[bungo]

I stand corrected, you have had a very unique experience. CWS is not something you would typically find in an undergrad curriculum.

People interested in medicine generally shadow doctors during undergrad.

 

[JMK2005]

Although rare I've seen vision damage to drug toxicity from amiodarone and ethambutol, which while not systemic diseases, they were indicative of drug toxicity.

Even with daddy as a retina specialist, this statement is above the level of any pre-med. I call BS. I agree with PBEA.

 

[FutureCTDoc]

Even with daddy as a retina specialist, this statement is above the level of any pre-med. I call BS. I agree with PBEA.

I'm flattered, however I am a pre-med. I'm in the NSU BS/DO.

 

[Meibomian SxN]

I'm flattered, however I am a pre-med. I'm in the NSU BS/DO.

What "vision damage" was caused by amiodarone?

 

[FutureCTDoc]

What "vision damage" was caused by amiodarone?

Toxicity to the optic nerve, if I recall correctly.

 

[DKofLV]

Toxicity to the optic nerve, if I recall correctly.

He is correct. I assume meibomian wanted to make him/her feel stupid because of the default that corneal verticillata doesnt actually injure the vision (though it can cause disturbing halos)...but remember, optic neuropathy occurs in <1% of people (which can be quite devastating). Additionally, optic disk edema and reversible VF defects are possible too.

 

[Meibomian SxN]

He is correct. I assume meibomian wanted to make him/her feel stupid because of the default that corneal verticillata doesnt actually injure the vision (though it can cause disturbing halos)...but remember, optic neuropathy occurs in <1% of people (which can be quite devastating). Additionally, optic disk edema and reversible VF defects are possible too.

Why would you assume that? Instead of accusing them of fabrication like your colleagues, I asked since they have seen a wide variety of interesting cases.

Actually it would have been easier to make you look stupid, since you concentrate on titrating diabetics instead of ophthalmic surgery.

 

[DOCTORSAIB]

What "vision damage" was caused by amiodarone?

Why is "vision damage" in quotations?

Sounds to me like you were trying to one-up the premed student. Nice try.

 

[DKofLV]

Actually it would have been easier to make you look stupid, since you concentrate on titrating diabetics instead of ophthalmic surgery.

any chance you might get a life and go back to the OD forums where people care what you think?

 

[Meibomian SxN]

Why is "vision damage" in quotations?

Sounds to me like you were trying to one-up the premed student. Nice try.

Just to emphasize; I was hoping to hear an interesting case. Sounded like a verbatim response regardless but I gave them the benefit of the doubt.

 

[VA Hopeful Dr]

Actually it would have been easier to make you look stupid, since you concentrate on titrating diabetics instead of ophthalmic surgery.

This may be hard to believe, but surgeons are responsible for their patients' health too. I don't find it hard to believe at all that an ophtho resident only a year or two out of their intern year would still be able to and still want to get their patient's diabetes under control themselves before/after surgery, especially if said patient is staying in the hospital.

Things are different in academic settings compared to the PP ophtho people I'm sure you're used to working with.

 

[DKofLV]

What "vision damage" was caused by amiodarone?
-------------------
Just to emphasize; I was hoping to hear an interesting case. Sounded like a verbatim response regardless but I gave them the benefit of the doubt.

We all know the latter isnt true. If you were hoping to hear an interesting case, you wouldnt have just left it at that in quotes. You would have probably said something along the lines of, (here come the quotes) "Interesting, any specific cases of vision damage/optic neuropathy you could share? I'd be very interested." The above looks mocking

anyways, I better get back to the hospital and titrate a blood sugar on my diabetic...I dont know how to do anything else anyways...

 

[PBEA]

People interested in medicine generally shadow doctors during undergrad.

during which they usually learn squat

 

[DKofLV]

during which they usually learn squat

True, the majority dont learn anything...but apparently the above med student has paid a lot of attention and learned a pretty good amount. Keep in mind...MANY people want to go to med school and do things like shadow doctors, etc to enhance their CV. Some people later change their mind (cuz the shadowing was boring or they dont like medicine/people) or dont get into medical school...so the shadowing helps to not only teach a little medicine, but also expose the student to the world of medicine so they can decide if they love or hate it

 

[PBEA]

agreed

 

[MstaKing10]

Kudos to the undergrad for paying attention and actually learning something that many med students on an ophtho rotation wouldn't recall. I agree that shadowing during undergrad didn't lead to any significant learning in terms of diseases or clinical thought process. But it did give a better understanding of the lifestyle involved with being a physician. This may be a more practical learning experience for an undergrad wondering what to do with their lives.