Ocular Diseases and Glaucoma
Chat Highlights
July 9, 2003

Norma Devine, Editor

On Wednesday, July 9, 2003, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Ocular Diseases and Glaucoma."

Moderator:  Tonight's topic is "Ocular Diseases."  What's included under that topic?

Dr. Rick Wilson:  Any disease of the eye that can cause elevated IOP (intraocular pressure).  If you want to, you can even include systemic diseases.

P:  Is giant cell arteritis an ocular disease?

Dr. Rick Wilson:  It can be, although usually it is first seen in the temporal artery and is often called temporal arteritis.

Moderator:  What is giant cell arteritis?

Dr. Rick Wilson:  It is an inflammation of arteries in the head that can cause closure of the vessel, leading to decreased vision or blindness if the artery is the ophthalmic artery.

P:  Which systemic diseases can elevate IOP (intraocular pressure)?

Dr. Rick Wilson:  Anything that cause cause inflammation in the eye, such as juvenile rheumatoid arthritis, thyroid eye disease, blockage of the vessels behind the eye that can lead to elevated pressure in the veins that the eye drains into, etc.  

P:  What is sarcoidosis and what causes it?  

Dr. Rick Wilson:  Sarcoidosis is a common cause of inflammation in the eye from a systemic disease.  Intraocular infections such as herpes virus, toxoplasmosis, or histoplasmosis can cause enough inflammation to elevate eye pressure.

Moderator:  Would blepharitis also fall into that category?  

Dr. Rick Wilson:  Blepharitis is an inflammation or infection of the lid and may not be related to the eye at all.

P:  What about Graves' disease?

Dr. Rick Wilson:  Graves' disease is thyroid eye disease; the muscles around the eye thicken and pull on the globe, elevating IOP.

P:  What ocular indicators would suggest referring a patient for thyroid testing?

Dr. Rick Wilson:  Indicators would be eyes that protrude unnaturally, are quite red, or that the patient has trouble moving the eye naturally.  The thyroid on the front of the neck may be enlarged.

P:  Should people who are hypothyroid (myexedema) have their eyes checked periodically?  If so, how frequently?

Dr. Rick Wilson:  At east yearly; more frequently if the person is having symptoms.  

P:  Could you explain more about how juvenile rheumatoid arthritis (JRA) is connected to glaucoma?

Dr. Rick Wilson:  Patients with JRA have an autoimmune reaction against some of the tissues in their own bodies.  One of the tissues is the uvea, the middle layer of the eye.  Uveitis causes white cells to get into the aqueous, the watery fluid of the eye.  The aqueous becomes thicker as serum from the blood leaks into the eye.  Both the cells and the thicker aqueous make it more difficult for the fluid to exit the eye through the trabecular meshwork.

P:  What are some ophthalmic signs and symptoms of diabetes mellitus?

Dr. Rick Wilson:  The usual sign is small hemorrhages in the retina, as the diabetes affects the small vessels in the retina.  Then, tiny strokes occur in the retina, and large areas of the retina may not be getting enough blood flow.  The body reacts by trying to build more vessels.  These vessels grow in the front of the eye and often block the drain, causing neovascular glaucoma -- a very difficult type of glaucoma to treat.

Moderator:  A patient who couldn't be here wants to know whether aniridia affects glaucoma or IOP. 

Dr. Rick Wilson:  A large proportion of patients with aniridia get glaucoma, usually during their childhood, but possibly during their teenage years.  The lack of an iris makes the cornea more susceptible to injury if the front of the eye collapses during the postoperative period, or if more fluid escapes the trabeculectomy or aqueous shunt than the eye is producing. 

P:  I believe there are some investigators who view exfoliative glaucoma as an ocular expression of a systemic illness. Is that view now widely held? 

Dr. Rick Wilson:  Yes, pseudoexfoliative material can be found all over the body, but seems to do the most damage in the eye.

P:  I have a friend who has a prolapsed valve in her heart.  She began to have blurry vision and finally had laser surgery, which has reduced her vision considerably.  Have you heard of such a thing?

Dr. Rick Wilson:  Yes, she could easily have clots thrown off by the poorly working valve that were carried by arteries to the eye, where they finally lodged in a small artery and caused a stroke in the eye. If extensive, the clots may need to be treated with laser.

P:  I've read that endometriosis can be found in the eye.  Can it damage the eye?

Moderator:  First, Dr. Wilson, what is endometriosis?

Dr. Rick Wilson:  In endometriosis, tissue that usually lines the uterus is found in other parts of the body.  The uterine tissue has nowhere to slough off and be gotten rid of, as with menses.  I would assume it would cause a space-occupying lesion, which could crowd other parts of the eye.  (This is really taking me back.)  

P:  What a memory, Dr. Wilson!

Dr. Rick Wilson:  Yes, but don't ask me what I ate yesterday.

End of highlights for July 9, 2003.

On July 16, Dr. Wilson discussed "Communication Between Doctors, Patients and Family" in the Chat room. Click here for highlights of that meeting.

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