Autoimmune Disease and the Eye - Amazon S3

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Autoimmune Disease and the Eye

Anthony DeWilde, OD FAAO

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Disclosure

Financial disclosures: No financial disclosures

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Goals

Manifestations Diagnosis/Treatment Referral

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Autoimmune Disease

Ankylosing Spondylitis Chron's Disease Giant Cell Arteritis Graves' Disease Lupus Erythematosus Multiple Sclerosis

Myasthenia Gravis Psoriasis Rheumatoid Arthritis Sarcoidosis Sj?gren's Syndrome Ulcerative Colitis

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External

Ptosis Exophthalmos Diplopia

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Ptosis

Myasthenia Gravis Any patient with Diplopia or Ptosis

Especially women under 40, men over 60

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Myasthenia Gravis

Greek and Latin meaning "grave muscle weakness"

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Myasthenia Gravis

Chronic autoimmune neuromuscular disease Muscle weakness and fatigue Eyelid muscles first affected in most cases

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Myasthenia Gravis

15% have Ocular only 80% have some ocular manifestation

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Myasthenia Gravis

Can involve breathing and swallowing Myasthenic Crisis

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Myasthenia Gravis

Antibodies destroy or alter receptors for acetylcholine

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Myasthenia Gravis

In office testing Ice-pack test Upgaze test Cogan lid twitch Orbicularis resistance

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Arq. Bras. Oftalmol. vol.73 no.2 S?o Paulo Mar./Apr. 2010

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Myasthenia Gravis

Other testing Tensilon Acetylcholine receptor antibodies Anti-MuSK antibody (muscle specific kinase) EMG

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Myasthenia Gravis

Treatment Cholinesterase inhibition (pyridostigmine) Corticosteroid Immunosuppressants Plasmapharesis Intravenous IVIg

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Myasthenia Gravis

Surgery 15% of MG patients have tumor of Thymus

Every patient needs Chest X-Ray or CT Often require Thymectomy

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Myasthenia Gravis

Refer to Neurology Test Thymus Test for generalized Myasthenia Gravis

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Myasthenia Gravis

RH - 55 yo WM Healthy eyes New CN IV Palsy +DM, +HTN NO neuro symptoms

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Myasthenia Gravis

Resolved 6 weeks later

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Myasthenia Gravis

4 months later Ptosis Ice pack

Pre 2 mm Post 9 mm

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Myasthenia Gravis

Upgaze fatigue + Cogan lid twitch AchR Antibodies very elevated

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Myasthenia Gravis

RH has difficulty with meds Variable diplopia!!

What's best Tx for this? Remains ocular only

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