Systemic Disease and Ocular Manifestations
Systemic disease items ask you to connect a medical condition or medication to a specific ocular finding and a management step.
Disease-to-eye links
Diabetes: retinopathy, macular edema, cataract, and cranial nerve palsies. Hypertension: arteriovenous nicking, flame hemorrhages, and macroaneurysms. Hyperlipidemia: arcus and xanthelasma. Thyroid disease: lid retraction, proptosis, diplopia, and compressive optic neuropathy, which is urgent. Sarcoidosis: granulomatous uveitis, conjunctival nodules, and candle-wax retinal drippings. Syphilis: any uveitis, especially with rash or neurologic signs - check serology. Rheumatoid arthritis: scleritis and peripheral ulcerative keratitis, both vision-threatening. Myasthenia: fatigable ptosis and diplopia, with a positive ice test. HIV with CD4 below 50: CMV retinitis.
Medication surveillance
Hydroxychloroquine: baseline examination, then annual screening after five years with visual fields, OCT, and multifocal ERG. Ethambutol: dose-related optic neuropathy with color loss. Amiodarone: vortex keratopathy and, rarely, optic neuropathy. Topiramate: acute angle closure from supraciliary effusion. Tamsulosin: intraoperative floppy iris syndrome - tell the surgeon. Chronic steroids: cataract and pressure rise.
Worked example
A 55-year-old woman with long-standing rheumatoid arthritis has a deep, boring red eye with photophobia and scleral thinning; acuity is normal. Reasoning: scleritis, not conjunctivitis - the pain is severe and deep, vessels blanch with phenylephrine, and there is no discharge. Urgent rheumatology referral for systemic control, since necrosis and perforation are possible; topical therapy alone is inadequate.
Traps
Treating a red eye as allergic when it is scleritis; missing giant cell arteritis behind a headache; forgetting to review the medication list; and ignoring bilateral disc swelling as benign.