Imran Akram, Amjad Akram.
Systemic disorders presenting to the Ophthalmologist.
J Coll Physicians Surg Pak Jan ;11(5):328-9.

Ophthalmologists are uniquely placed among clinicians in being able to directly visualise various vascular and inflammatory conditions involving the blood vessels of the eye through the ocular media. Although common systemic disorders like diabetes, hypertension and various arthritides frequently involve the eye, very occasionally a patient harbouring an occult systemic condition may first present to an ophthalmologist with symptoms related to eye involvement rather than symptoms from the systemic disorder. Two examples are quoted here in its support. In both middle-aged men presented with unilateral decrease in vision without any other complaint. One of them was later found to be diabetic and the other was ultimately diagnosed as having pancreatic carcinoma.

Case Report: A 53 years old Caucasian man presented to our eye casualty with a one week history of painless blurred vision in the left eye. He was a moderate smoker otherwise his general health was quite good and he was taking no regular medication. He had a brother who was diagnosed as diabetic at the age of 52 years. Examination showed an unaided Snellens visual acuity of 6/6 in each eye. Colour vision (tested with Ishihara charts) was normal. Confrontation showed an obvious inferior visual field defect due to a left relative afferent pupil defect in the left eye. Intraocular pressure was normal and the anterior segments were otherwise unremarkable. The right fundus was normal. The left optic disc was swollen with a splinter hemorrhage and a cotton-wool spot at its nasal border. A Goldman visual field test confirmed the left inferior altitudinal field defect. An urgent ESR done was 6 mm/hour. MRI of the optic nerves and orbits was normal. The patient was diagnosed as a case of left non-arteritic anterior ischaemic optic neuropathy (AION) and blood tests including FBC, fasting glucose and autoantibodies were ordered. The only abnormality detected was fasting blood glucose of 6.1 mmol. The patient was then referred to the diabetologists who confirmed an impaired glucose tolerance and arranged dietary advice

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