Chronic anemia

• Pale fundus
• Tortuous veins

Pernicious anemia

• Flame shaped hemorrhages
• Pre-retinal hemorrhage
• 5% develop retro-bulbar neuritis

Massive hemorrhage anemia

• Sudden blindness due to:
• Central retinal artery spasm (Reversible)
• Central retinal artery occlusion (Irreversible)

Leukemia

• Retinal pallor

Polycythemia vera

• Retinal veins are dark, tortuous, and dilated
• Retinal arteries are normal
• Retinal hemorrhages

Fabry’s disease

• Conjunctival tortuosity
• Corneal swirls
• High lipids

Gout

• 90% middle age men
• Chronic conjunctivitis
• Episcleritis
• Scleritis
• Corneal crystals

Homocystinuria

• Dislocated lens
• Fair complexion

Hyperthyroidism

Graves disease

Signs

• Ballet’s sign Extraocular muscle palsies
• Cowan’s sign Jerky consensual pupil reflex
• Dairymple’s sign Lid retraction
• Grove’s sign Lid resistance on downward gaze
• Jellinek’s sign Increased lid pigmentation
• Joffroy’s sign Weak forehead wrinkling on up gaze
• Knie’s sign Unequal pupil dilation
• Moebius’ sign Poor convergence
• Riesman’s sign Bruit over closed eye
• Rosenbach’s sign Tremor of closed lids
• Stellwag’s sign Infrequent blink rate
• Suker’s sign Weak lateral gaze fixation
• Von Graefe’s sign Lid lag on down gaze

• 7:1 Female
• Nervous
• Overactive
• Tremor
• Sensitive to heat, sweating
• Weight loss
• Goiter
• Red nodules on anterior lower legs
• Smooth skin
• Clubbed digits
• Proptosis
• Exposure keratitis

Hypervitaminosis A

• Band keratopathy
• Conjunctival deposits

Hypovitaminosis A

• Xerophthalmia
• Corneal and conjunctival keratinization
• Corneal ulceration
• Night blindness
• "Bitot's spot"
• Foamy area at limbus pointing to outer canthus
• Corneal perforation

Hypervitaminosis B1

• Beriberi
• Polyneuritis
• Optic atrophy

Hypovitaminosis B2

• Pellagra
• Optic atrophy

Hypovitaminosis C

• Scurvy
• Hemorrhages

Hypoparathyroidism

• Chovstek’s sign
• Tap facial at zygomatic arch makes orbicularis twitch
• Troussseau’s sign
• Tetany of hand after 2 min. with sphgmomometor
• Tingling in lips and fingers
• Cataracts
• Keratitis

Hypothyroidism

• Hashimotos disease most common cause
• 20-50 yr. old females
• Lethargy
• Confusion
• Forgetfulness
• Voice changes
• Cool skin
• Brittle hair
• Alopecia
• Hypothermia
• Poor stress management
• Ptosis
• Edema
• Cataract
• Keratoconjunctiva sicca
• Extraocular muscle myotonia
• Loss of lateral 1/3 of eyebrows

Hypovitaminosis

• Xerosis

Cystinosis

• Photophobia
• Headaches
• Burning, itchy eyes
• Hexagonal cystine crystals in corneal stroma

Nephrotic syndrome

• High urine protein loss leads to edema

Uremia

• Chronic renal failure
• Band keratopathy

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Last modified: May 1, 2006