Eye Problems in Systemic Disease
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Eye Problems in Systemic Disease

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Questions and Answers

What is the primary cause of proptosis in adults according to the content?

Thyroid Eye Disease (TED)

Which thyroid condition affects 40% of patients with Graves disease in relation to ocular symptoms?

Hyperthyroidism

List two ocular manifestations associated with Cushing's disease.

Cataract and exophthalmos

What are the symptoms associated with Grade 2/3 hypertensive retinopathy?

<p>Blurring of vision, headache, and diplopia.</p> Signup and view all the answers

Name one management strategy for Thyroid Eye Disease (TED).

<p>Orbital decompression surgery</p> Signup and view all the answers

What is the relationship between hypertensive retinopathy and diabetes?

<p>Diabetes increases the risk of developing hypertensive retinopathy.</p> Signup and view all the answers

Identify two ocular symptoms of suprasellar tumors affecting the hypothalamus.

<p>Optic atrophy and papilloedema.</p> Signup and view all the answers

What does AV nicking indicate in the context of hypertensive retinopathy?

<p>Arteriolar narrowing at the crossing of arteries and veins.</p> Signup and view all the answers

What role can ophthalmologists play in the diagnosis of systemic diseases?

<p>Ophthalmologists can often identify signs of systemic diseases through eye examinations, which may lead to the diagnosis of such conditions before other symptoms emerge.</p> Signup and view all the answers

Identify two endocrine disorders that significantly affect eye health.

<p>Diabetes mellitus and thyroid dysfunction are two significant endocrine disorders that can affect eye health.</p> Signup and view all the answers

What is the primary systemic disease associated with blindness in working-age individuals?

<p>Diabetes mellitus is the primary systemic disease associated with blindness among individuals aged 20 to 65 years.</p> Signup and view all the answers

List two types of systemic diseases that can lead to eye problems.

<p>Infectious diseases and neurological disorders are two types of systemic diseases that can lead to eye problems.</p> Signup and view all the answers

How can eye problems serve as indicators of systemic diseases?

<p>Eye problems can serve as early warning signs, indicating the presence of underlying systemic diseases that require further investigation.</p> Signup and view all the answers

What is the normal blood pressure target for treating hypertensive retinopathy?

<p>Below 140/90 mmHg.</p> Signup and view all the answers

List two conditions associated with malignant hypertension.

<p>Eclampsia of pregnancy and pheochromocytoma.</p> Signup and view all the answers

What causes retinal vein occlusion primarily?

<p>Thrombus formation and external compression of the vein.</p> Signup and view all the answers

What role does age play in the incidence of retinal vein occlusion?

<p>Over 50% of cases occur in individuals over 65 years old.</p> Signup and view all the answers

Identify two cardiovascular diseases that can lead to eye problems.

<p>Atrial fibrillation and aortic stenosis.</p> Signup and view all the answers

What is the 4-2-1 rule in the context of severe diabetic retinopathy?

<p>The 4-2-1 rule indicates severe diabetic retinopathy when there are hemorrhages and microaneurysms in 4 quadrants, venous beading in at least 2 quadrants, or intraretinal microvascular abnormalities in at least 1 quadrant.</p> Signup and view all the answers

What are the late complications of proliferative diabetic retinopathy?

<p>The late complications include tractional retinal detachment and diabetic maculopathy.</p> Signup and view all the answers

How does fluorescein angiography assist in diagnosing proliferative diabetic retinopathy?

<p>Fluorescein angiography reveals wide areas of capillary dropout and ischemia in the retina.</p> Signup and view all the answers

What is the role of blood sugar and blood pressure control in diabetic retinopathy?

<p>Blood sugar and blood pressure control are as important as laser treatment in reducing the risk of retinopathy progression and vision loss.</p> Signup and view all the answers

What is the significance of Rubeosis Iridis in diabetic patients?

<p>Rubeosis Iridis indicates neovascularization on the iris, which can lead to neovascular glaucoma.</p> Signup and view all the answers

Describe the typical visual field defect associated with pituitary tumors.

<p>The typical visual field defect is bitemporal hemianopia, where the outer parts of the visual field are lost.</p> Signup and view all the answers

In the context of diabetic maculopathy, how does hyperlipidaemia treatment impact patient outcomes?

<p>Active treatment of hyperlipidaemia is shown to benefit diabetics suffering from exudative maculopathy with extensive lipid exudates.</p> Signup and view all the answers

What distinguishes ischaemic maculopathy from exudative maculopathy in diabetic patients?

<p>Ischaemic maculopathy is not treatable, while exudative maculopathy can be managed with focal laser treatments.</p> Signup and view all the answers

What is the estimated prevalence of blindness due to diabetic retinopathy in Western communities?

<p>Between 1.6 and 1.9 per 100,000.</p> Signup and view all the answers

List at least two visual problems that may occur due to diabetes.

<p>Diabetic retinopathy and cataract.</p> Signup and view all the answers

What pathological changes occur in the retina due to hyperglycemia?

<p>Basement membrane thickening and increased free radical activity.</p> Signup and view all the answers

Describe the process that leads to the release of VEGF in diabetic retinopathy.

<p>Ischaemia in the retina directly affects rods and cones, causing VEGF release for new blood vessel formation.</p> Signup and view all the answers

Differentiate between the stages of diabetic retinopathy.

<p>The stages include Background, Preproliferative, Proliferative, and Maculopathy.</p> Signup and view all the answers

What characterizes mild non-proliferative diabetic retinopathy?

<p>The presence of at least one microaneurysm without severe hemorrhages.</p> Signup and view all the answers

What are Cotton Wool Spots and what do they indicate in relation to diabetic retinopathy?

<p>Cotton Wool Spots are microinfarcts of the nerve fiber layer, often associated with other preproliferative signs.</p> Signup and view all the answers

How can proliferative diabetic retinopathy evolve over time?

<p>It can evolve very quickly, sometimes within a span of six weeks.</p> Signup and view all the answers

Name one systemic disease that can lead to eye problems.

<p>Diabetes Mellitus</p> Signup and view all the answers

How might eye problems indicate the presence of a systemic disease?

<p>Eye problems may serve as early signs of systemic diseases, prompting ophthalmologists to diagnose conditions based on ocular symptoms.</p> Signup and view all the answers

What is the most significant cause of blindness in individuals aged 20-65 years?

<p>Diabetes Mellitus</p> Signup and view all the answers

Identify one endocrine disorder that significantly affects eye health.

<p>Thyroid dysfunction</p> Signup and view all the answers

Explain how systemic diseases can be diagnosed first by ophthalmologists.

<p>Ophthalmologists can detect signs of systemic diseases through eye examinations, which may reveal symptoms unnoticed by other medical professionals.</p> Signup and view all the answers

What is a common review timeline for patients with severe diabetic retinopathy?

<p>Patients typically require a review in 4 months.</p> Signup and view all the answers

What is neovascularization in the context of proliferative diabetic retinopathy?

<p>Neovascularization refers to the growth of new blood vessels, which can bleed and lead to vision complications.</p> Signup and view all the answers

What are two systemic risk factors that can worsen diabetic retinopathy?

<p>Uncontrolled blood sugar levels and hypertension are two significant risk factors.</p> Signup and view all the answers

How does focal laser therapy assist in managing exudative maculopathy?

<p>Focal laser therapy targets and seals leaks from abnormal retinal capillaries, reducing fluid accumulation.</p> Signup and view all the answers

How does diabetic maculopathy affect vision?

<p>Diabetic maculopathy can distort vision due to fluid leakage and lipid exudate accumulation.</p> Signup and view all the answers

What can occur as a late complication of proliferative diabetic retinopathy?

<p>Tractional retinal detachment can occur as a late complication.</p> Signup and view all the answers

What imaging technique is used to assess capillary dropout in diabetic retinopathy?

<p>Fluorescein angiography is used to examine capillary dropout.</p> Signup and view all the answers

What is Rubeosis Iridis and why is it significant?

<p>Rubeosis Iridis is the abnormal growth of new vessels on the iris, indicating severe ischemic changes.</p> Signup and view all the answers

How can Thyroid Eye Disease (TED) impact a patient's vision?

<p>TED can lead to vision loss in 4-8% of patients due to complications such as dysthyroid myopathy and optic neuropathy.</p> Signup and view all the answers

What is a common ocular manifestation seen in patients with Addison's disease?

<p>A common ocular manifestation in Addison's disease is hyperpigmentation.</p> Signup and view all the answers

Describe the ophthalmic signs associated with hypertensive retinopathy.

<p>Signs include Cotton Wool Spots, flame-shaped hemorrhages, and AV nicking.</p> Signup and view all the answers

What role do lubricants play in the management of Thyroid Eye Disease?

<p>Lubricants help alleviate symptoms of dry eyes and conjunctival hyperemia associated with TED.</p> Signup and view all the answers

What is the primary ocular consequence of malignant hypertension?

<p>The primary ocular consequence is optic disc swelling, leading to blurred vision and field loss.</p> Signup and view all the answers

How can diabetes exacerbate the effects of hypertensive retinopathy?

<p>Diabetes increases the risk of severe retinal damage in hypertensive retinopathy.</p> Signup and view all the answers

What are some surgical options available for managing Thyroid Eye Disease?

<p>Surgical options include orbital decompression surgery and muscle surgery.</p> Signup and view all the answers

What ocular symptom is commonly associated with keratoconjunctivitis sicca in TED patients?

<p>Common symptoms include dryness and irritation of the eyes.</p> Signup and view all the answers

What is the target blood pressure for treating hypertensive retinopathy?

<p>Below 140/90 mmHg.</p> Signup and view all the answers

What can cause disc edema in hypertensive retinopathy?

<p>Severe hypertension, potentially reaching 250/150 mmHg.</p> Signup and view all the answers

What is a common etiology for retinal vein occlusion?

<p>Hypertension is a common cause, affecting 64% of patients.</p> Signup and view all the answers

What are two potential complications of severe hypertensive retinopathy?

<p>Retinal/macular edema and disc edema.</p> Signup and view all the answers

Identify one systemic condition that can lead to malignant hypertension.

<p>Eclampsia of pregnancy.</p> Signup and view all the answers

What is indicated by the presence of at least one microaneurysm in non-proliferative diabetic retinopathy?

<p>It indicates mild non-proliferative diabetic retinopathy.</p> Signup and view all the answers

What are the three stages of diabetic retinopathy?

<p>The stages are non-proliferative, preproliferative, and proliferative diabetic retinopathy.</p> Signup and view all the answers

What does VEGF stand for and what is its role in diabetic retinopathy?

<p>VEGF stands for Vascular Endothelial Growth Factor, and it promotes new blood vessel formation.</p> Signup and view all the answers

What characterizes preproliferative diabetic retinopathy?

<p>It is characterized by venous beading, intraretinal microvascular abnormalities, and severe hemorrhages.</p> Signup and view all the answers

What are Cotton Wool Spots and what do they indicate?

<p>Cotton Wool Spots are soft exudates indicating microinfarcts of the nerve fiber layer.</p> Signup and view all the answers

What is the estimated prevalence of blindness due to diabetic retinopathy in Western communities?

<p>The prevalence is estimated to be between 1.6-1.9 per 100,000.</p> Signup and view all the answers

What are two visual problems that may occur due to diabetes?

<p>Diabetic retinopathy and cataracts are two visual problems.</p> Signup and view all the answers

What processes contribute to the pathology of diabetic retinopathy due to hyperglycemia?

<p>Key processes include basement membrane thickening and increased free radical activity.</p> Signup and view all the answers

Study Notes

Eye Problems in Systemic Disease

  • Systemic diseases can affect the eye in many ways, but ophthalmologists are often the first to diagnose these issues.
  • Diabetes mellitus is the most common cause of blindness in working-age individuals (20-65 years old), with a prevalence of 1.6-1.9/100,000
  • Vision issues in diabetes can occur due to diabetic retinopathy, cataracts, glaucoma, ischemic optic neuropathy, retinal vein and artery occlusions, and IIIrd, IVth, and VIth nerve palsies.

Diabetic Retinopathy

  • Hyperglycemia causes basement membrane thickening, non-enzymatic glycosylation, increased free radical activity, increased flux through the polyol pathway, and osmotic damage.
  • Diabetic retinopathy develops in stages: background (mild non-proliferative), preproliferative, proliferative, and maculopathy.
  • Background diabetic retinopathy is characterized by mild hemorrhages and microaneurysms (MAs), with no more severe changes.
  • Preproliferative diabetic retinopathy includes venous beading, intraretinal microvascular abnormalities (IRMAs), and severe hemorrhages.
  • Proliferative diabetic retinopathy has new vessels growing on the disc (DNV) and elsewhere on the retina (NVE).

Key Signs of Diabetic Retinopathy

  • Cotton-wool spots (CWS) are soft exudates that are microinfarcts of the nerve fiber layer. They are often associated with preproliferative diabetic retinopathy signs; however, isolated CWS may be caused by hypertension or recent stricter blood sugar control.

Classifying Diabetic Retinopathy

  • Non-proliferative Diabetic Retinopathy:

    • Mild: presence of at least 1 microaneurysm.
    • Moderate: presence of hemorrhages, microaneurysms, hard exudates, and cotton wool spots.
    • Severe: The 4-2-1 rule: hemorrhages and microaneurysms in 4 quadrants, venous beading in at least 2 quadrants, intraretinal microvascular abnormalities in at least 1 quadrant.

  • Proliferative Diabetic Retinopathy

    • Mild-moderate: neovascularization, vitreous/preretinal hemorrhage.
    • Severe: advanced neovascularization, vitreous/preretinal hemorrhage.

Treatment of Diabetic Retinopathy

  • Scattered laser pan-retinal photocoagulation (PRP) for proliferative diabetic retinopathy.
  • Focal laser/laser grid for exudative maculopathy.
  • Ischemic maculopathy is not treatable.
  • Anti-VEGF used for treatment.

Systemic Risk Factors and Diabetic Retinopathy

  • Blood sugar and blood pressure control are as beneficial as laser treatment in reducing the risk of retinopathy progression and vision loss.
  • Nephropathy is a risk factor for diabetic retinopathy.
  • Diabetics with exudative maculopathy and extensive lipid exudates benefit from active treatment of hyperlipidemia.

Endocrine Disorders and the Eye

  • Thyroid, pituitary, hypothalamus, parathyroids, and adrenals can all cause eye problems.

Pituitary Tumours

  • Headache, visual field defect (bitemporal hemianopia), optic nerve dysfunction, color deficit, visual deterioration, and optic atrophy are possible symptoms.
  • MRI scan and neuro referral are recommended for diagnosis and management.

Thyroid Eye Disease (TED)

  • TED is a manifestation of Grave's disease and is the most common cause of proptosis (unilateral or bilateral) in adults.
  • It can occur in patients with euthyroidism, hypothyroidism, or hyperthyroidism.
  • 40% of patients with Grave’s disease have eye signs, and 4-8% experience vision loss.

Other Endocrine Disorders Affecting the Eyes

  • Gland - Disorder - Ocular Manifestations:
    • Hypothalamus - Suprasellar tumors - Optic atrophy, papilledema
    • Parathyroids - Hyper/Hypoparathyroidism - Conjunctival & corneal calcification, cataract
    • Adrenals - Pheochromocytoma -Hypertensive retinopathy
    • Adrenals - Addison’s disease - Hyperpigmentation
    • Adrenals - Cushing’s disease - Cataract, exophthalmos

Hypertensive Retinopathy

  • Damage to the retina from high blood pressure, and the risk increases with duration.
  • Worse with diabetes, high cholesterol, smoking, and malignant hypertension.

Symptoms of Hypertensive Retinopathy

  • Grade 1: no symptoms.
  • Grade 2/3: blurring of vision, headache, diplopia.
  • Grade 4: optic disc swelling, which causes blurred vision and field loss.

Signs of Hypertensive Retinopathy

  • Cotton-wool spots (CWS) are common, especially with a diastolic blood pressure greater than 100 mmHg.
  • Flame-shaped hemorrhages, CWS, A-V nicking, arteriolar narrowing, arteriolar color changes, vessel sclerosis, threading can all be present.

Treatment of Hypertensive Retinopathy

  • Lower blood pressure to below 140/90 mmHg.

Malignant Hypertension

  • This can be caused by collagen vascular diseases, renal problems, eclampsia of pregnancy, and pheochromocytoma.

Cardiovascular Diseases that Cause Eye Problems

  • Atrial fibrillation, aortic stenosis, hyperlipidemia (arcus, xanthoma), hypercholesterolemia, and thromboembolism (retinal arteriolar occlusion).

Retinal Vein Occlusion

  • The second most common vascular disease causing loss of vision.

Retinal Vein Occlusion Pathophysiology

  • Thrombus formation, disease of the vein wall, external compression of the vein, can all contribute.
  • Thickening of the arteriole can compress the vein and cause occlusion.

Types of Retinal Vein Occlusion

  • Branch Retinal Vein Occlusion (BRVO)
  • Central Retinal Vein Occlusion (CRVO)

Retinal Vein Occlusion Etiology

  • Advancing age is a risk factor, especially over 65 years old.
  • Other risk factors include hypertension, hyperlipidemia, diabetes, smoking, obesity, raised intraocular pressure, inflammatory diseases (sarcoidosis, Behçet's syndrome), hyperviscosity states (myeloma), and thrombophilic disorders.

Eye Problems and Systemic Diseases

  • The eye is a unique organ often the first place to signal systemic diseases.

  • Endocrine disorders are a common cause of eye problems, especially diabetes mellitus, thyroid dysfunction, and pituitary tumors.

  • Diabetes mellitus is a leading cause of blindness in working-age individuals (20-65 years old).

    • The prevalence of blindness due to diabetic retinopathy in Western communities is estimated at 1.6-1.9 per 100,000 people.
    • Visual problems can occur due to diabetic retinopathy, cataracts, glaucoma, ischemic optic neuropathy, retinal vein and artery occlusions, and cranial nerve palsies.

  • Diabetic retinopathy (DR) is caused by high blood sugar (hyperglycemia).

    • Hyperglycemia leads to changes in blood vessels, including thickening of the basement membrane, non-enzymatic glycosylation, increased free radical activity, increased flux through the polyol pathway, and osmotic damage.
    • Ischemia results from the damage to the retinal blood vessels.
    • Ischemia damages photoreceptors (rods and cones), and leads to release of vascular endothelial growth factor (VEGF), which promotes new blood vessel formation (neovascularization).
    • Neovascularization bleeds and scars contributing to vision impairment.
    • DR stages include background diabetic retinopathy, preproliferative diabetic retinopathy, and proliferative diabetic retinopathy.
    • Background diabetic retinopathy is characterized by mild hemorrhages and microaneurysms.
    • Preproliferative diabetic retinopathy includes venous beading, intraretinal microvascular abnormalities (IRMA), and severe hemorrhages.
    • Proliferative diabetic retinopathy involves new vessel growth on the optic nerve (disc neovascularization) or on other retinal surface areas (neovascularization elsewhere).
    • In the latter stages of DR, new vessels tend to bleed, leading to vitreous hemorrhages and tractional retinal detachment.

Diabetes and Retinopathy

  • The 4-2-1 rule: one or more hemorrhages and microaneurysms in four quadrants, venous beading in at least two quadrants, and intraretinal microvascular abnormalities in at least one quadrant characterize severe non-proliferative diabetic retinopathy.

  • Proliferative DR is characterized by neovascularization (new blood vessel growth), vitreous hemorrhages, and preretinal hemorrhages.

  • Diabetic maculopathy involves exudates, fluid leakage, and retinal ischemia.

    • There are three types of diabetic maculopathy: exudative, ischemic, and mixed exudative/ischemic.

  • New vessel growth on the iris (rubeosis iridis) can lead to neovascular glaucoma.

    • Rubeosis iridis is caused by ischemia of the iris.
    • Neovascular glaucoma is a type of glaucoma that is caused by new blood vessels growing on the iris.

Treating Diabetic Retinopathy

  • Diabetic retinopathy often progresses with elevated blood sugar and blood pressure.
    • Control of both is as effective as laser treatment in reducing the risk of disease progression and vision loss.
  • Treatment options for DR include pan-retinal photocoagulation (PRP), focal laser, laser grid for exudative maculopathy, and anti-VEGF therapy
    • PRP is used to treat proliferative DR
    • Focal laser and laser grid are used to treat exudative maculopathy.
    • There is no treatment for ischemic maculopathy.
    • Anti-VEGF therapy is a newer treatment option for DR.
  • Hyperlipidemia (high blood cholesterol) in the setting of diabetic maculopathy may benefit from treatment.

Pituitary Tumors

  • Pituitary tumors can affect the optic nerve, and cause a variety of visual problems, including optic atrophy, color deficit, visual deterioration, and bitemporal hemianopia.
  • MRI imaging and neurological referral should be performed.

Thyroid Eye Disease (TED)

  • TED is a manifestation of Grave’s disease.
    • TED can occur in patients with euthyroidism, hypothyroidism, and hyperthyroidism.
      • TED may occur before the onset of hyperthyroidism or after treatment of hyperthyroidism.
    • TED may worsen in patients who are hypothyroid due to hyperthyroidism overtreatment.
    • TED can be seen in 40% of patients with Graves disease.
    • TED can cause vision loss in 4 to 8% of patients.
  • TED is the most common cause of proptosis (bulging eyes) in adults.
    • TED may be unilateral or bilateral.
  • TED can also cause a number of other symptoms, including lid lag, lid retraction, conjunctival hyperemia and chemosis, dry eye, dysthyroid myopathy, and optic neuropathy.

Treating Thyroid Eye Disease

  • Treatment includes controlling thyroid status (medication or surgery), lubricants, orbital decompression surgery, muscle surgery (with prisms in eyeglasses to correct misalignment), and lid surgery.

Other Endocrine Disorders:

  • Hypothalamus: Suprasellar tumors can lead to papilledema and optic atrophy.
  • Parathyroid: Hyperparathyroidism and hypoparathyroidism can cause conjunctival and corneal calcification, and cataracts.
  • Adrenals: Pheochromocytoma causes hypertensive retinopathy.
  • Adrenals: Addison’s disease can cause hyperpigmentation of the skin.
  • Adrenals: Cushing’s disease is associated with cataracts and exophthalmos.

Hypertensive Retinopathy

  • Hypertensive retinopathy occurs when high blood pressure damages the retina.
  • The longer the high blood pressure, the greater the risk of hypertensive retinopathy.
  • Hypertension is a significant risk factor for retinal vein occlusion.
  • Other risk factors for hypertensive retinopathy include diabetes, high cholesterol, and smoking.
  • Malignant hypertension is a severe form of hypertensive retinopathy accompanied by headache and diplopia.
    • Malignant hypertension is associated with papilledema and macular edema.
    • Malignant hypertension usually occurs with other medical conditions such as collagen vascular diseases, scleroderma, renal problems, eclampsia of pregnancy, and pheochromocytoma.
    • Malignant hypertension is a medical emergency.

Signs and Symptoms of Hypertensive Retinopathy

  • The symptoms of hypertensive retinopathy vary depending on the severity of the condition.
    • Grade 1 hypertensive retinopathy has no symptoms.
    • Grade 2 and 3 hypertensive retinopathy may cause blurred vision, headache, and diplopia.
    • Grade 4 hypertensive retinopathy is rare but serious.
      • Grade 4 is associated with papilledema.
        • Papilledema is a swelling of the optic disc that occurs when there is increased pressure in the brain.
  • Ophthalmoscopic findings of hypertensive retinopathy include flame-shaped hemorrhages, cotton wool spots, arteriolar narrowing (focal or diffuse), arteriolar color changes, AV nicking, and vessel sclerosis.

Treating Hypertensive Retinopathy

  • Blood pressure should be lowered to below 140/90 mmHg.

Cardiovascular Diseases

  • Aortic stenosis, atrial fibrillation, hyperlipidemia, hypercholesterolemia, and thromboembolism can cause eye problems.
    • Aortic stenosis can cause retinal artery occlusion and choroidal ischemia.
    • Atrial fibrillation increases risk of retinal artery occlusion and ischemic stroke.
    • Hyperlipidemia can cause arcus (a ring around the cornea), xanthalasma, and corneal neovascularization.
    • Hypercholesterolemia can cause retinal artery occlusion.
    • Thromboembolism causes retinal artery occlusion.

Retinal Vein Occlusion

  • Retinal Vein Occlusion (RVO) is the second most common vascular disease causing loss of vision.
  • There are two types of RVO: central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO).

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Explore how systemic diseases, particularly diabetes, impact eye health. Learn about the different stages of diabetic retinopathy and other related vision issues. This quiz will help deepen your understanding of these critical ocular conditions associated with systemic diseases.

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