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Diabetes and hypertension aren't the only systemic entities we see that involve ocular signs and symptoms.
The eye reacts in a limited number of ways to different disease processes. As eye doctors, we are most commonly confronted with the ocular manifestations of diabetes and hypertension. However, we can't forget to consider other possible systemic causes of similar ocular signs and symptoms when these common culprits are not involved.
The aim of the following three case reports is to illustrate the importance of such considerations while reviewing the diagnosed conditions.
case 1: Cancer Diagnosed from a Routine Eye Exam
A 55-year-old black female with no visual complaints presented to our clinic for a routine eye exam. Her ocular history was positive for a chalazion removal and a family history of glaucoma (mother). Her medical history was positive for hyperlipidemia. She was not taking any medications.
Her entering corrected visual acuity was 20/20 O.U. both distance and near. Her pupils were equal, round and reactive to light with no afferent pupillary defect. Extraocular motilities were full and smooth. Frequency doubling central 20-5 screening visual fields were full O.U.
Slit lamp examination of the anterior segment revealed mild blepharitis O.U. The cornea and conjunctiva were unremarkable. A deep and quiet anterior chamber along with a flat, brown iris was observed O.U. There was grade 1 nuclear sclerosis, and her intraocular pressures were 17mm Hg O.U.
A dilated fundus exam revealed healthy, average-sized optic nerves with an asymmetric cup to disc ratio of 0.35 h/v O.D. and 0.55 h/v O.S. The retinal nerve fiber layer appeared normal with mild attenuation of the retinal arterioles O.U. Both maculae were clear with dull foveal reflexes present. The peripheral retina was unremarkable O.S., but the superior temporal quadrant of the right eye had sheathed vessels with areas of intraretinal hemorrhage. Her blood pressure was 120/75, right arm seated.
* Diagnosis: The patient was diagnosed with a peripheral vascular occlusion O.D. without a history of vascular disease.
* Treatment and follow-up: Because the patient had no history of vascular disease and was already followed by her primary care provider with regular physical exams, the patient was sent for laboratory testing including a CBC (with differential, PT, PTT, ESR, ANA, RF, RPR,...