Ophthalmic Education:

International Curriculum Guidelines on Medical Student Education in Ophthalmology: 9. Ocular Manifestations of Systemic Disease

On this page:

• i) Diabetes*
  
  
• ii) Sickle cell anemia
  
  
• iii) Hypertension
  
  
• iv) Cerebrovascular diseases
  
  
• v) Thyroid (Graves) disease
  
  
• vi) Sarcoidosis/inflammatory conditions**
  
  
• vii) Malignancy
  
  
• viii) AIDS
  
  
• ix) Syphilis
  
  
• x) Other systemic infections
  
  
• Competencies
  
  
• Educational Priorities

The International Council of Ophthalmology Task Force on Medical Student Education in Ophthalmology

Draft, September 16, 2003

I. Diabetes*

1. Anterior segment
   
   1. corneal wound healing***
      
   2. cataract*
2. Posterior segment
   
   1. diabetic retinopathy*
      
      1. background retinopathy-hard exudates, hemorrhages, microaneurysms*
         
      2. preproliferative retinopathy-soft exudates, intraretinal microrovascular abnormality***
         
      3. proliferative retinopathy ? neovascularization of the disc, neovascularization elsewhere*
   2. vitreous hemorrhage*
      
   3. ischemic optic neuropathy***

II. Sickle cell anemia

1. Anterior segment
   
   1. importance of recognizing traumatic hyphema**
      
   2. anterior segment ischemia***
2. Posterior segment
   
   1. salmon patch***
      
   2. black sunburst***
      
   3. sea fan***

III. Hypertension

1. Posterior segment
   
   1. arteriolar narrowing*
      a. copper wire
      b. silver wire
   2. hemorrhages (flame-shaped)*
      
   3. exudates (cotton wool spots, macular star)*
      
   4. disc edema (malignant hypertension)*
2. Neuro-ophthalmic manifestations
   
   1. Cranial nerve palsy**
      
   2. intracranial hemorrhage**

IV. Cerebrovascular diseases

1. Transitory Ischemia Attack (TIA)*
   
   1. visual changes*
      
   2. fundus findings**
2. Infarction
   
   1. history*
      
   2. visual field findings*
      a. homonymous hemianopia
      b. homonymous quadrantanopia

V. Thyroid (Graves) disease

1. Clinical (Werner classification)*
   
2. Treatment for thyroid orbitopathy**
   
   1. non-surgical**
      a. corticosteroids
      b. radiation
   2. surgical***
      a. eyelid
      b. orbital decompression

VI. Sarcoidosis/inflammatory conditions**

1. Clinical
   
   1. nodules
      a. eyelid
      b. conjunctival
   2. uveitis
      a. non-granulomatous***
      (associated diseases-JRA, Reiter, Behcet)
      b. granulomatous***
      (associated diseases-sarcoid, Tb, fungal)
2. Diagnostic tests
   
   1. Imaging, gallium scan**
      
   2. ACE level**

VII. Malignancy

1. Primary
   
   1. intraocular**
      a. retinoblastoma**
      b. uveal malignant melanoma**
      c. lymphoma***
   2. eyelid
      a. basal cell carcinoma**
      b. sebaceous carcinoma**
      c. melanoma***
   3. orbit
      a. lymphoma***
      b. lacrimal gland tumors***
      c. other
2. Secondary
   
   1. extension from sinus carcinoma***
      
   2. metastasis***
      a. adults-carcinoma
      b. children-leukemia

VIII. AIDS

1. Anterior segment
   
   1. bacterial infections of the lids and adnexa*
      
   2. Kaposi sarcoma*
      (conjunctiva or eyelid)
      
   3. Conjunctival tumors
2. Posterior segment
   
   1. CMV retinitis*

IX. Syphilis

1. Anterior segment
   
   1. interstitial keratitis***
      
   2. anterior uveitis**
2. Posterior segment
   
   1. neuroretinitis**
      
   2. papillitis***
      
   3. posterior uveitis***

X. Other systemic infections

1. Viral (e.g. herpes zoster ophthalmicus "shingles")*
   
2. Fungal (e.g. candida endophthalmitis)***
   
3. Bacterial (e.g. Tb uveitis)***
   
4. Toxoplasmosis
   
5. Onchocerciasis

Competencies

• Student should
  • Recognize retinal exudates and hemorrhages on dilated fundus exam*
    
  • Detect hyphema on slit lamp exam***
    
  • Recognize retinal arteriolar narrowing (copper wire/silver wire) on dilated fundus exam*
    
  • Detect disc edema on fundus exam with direct ophthalmoscopy*
    
  • Perform neurologic Examination of all cranial nerves*
    
  • Perform confrontional visual fields with recognition of hemianopias*
    
  • Recognize limited ocular motility*
    
  • Recognize proptosis*
    
  • Recognize photophobia as symptom of uveitis*
    
  • Assess for malignant neoplasms of eyelids (carcinoma, melanoma)***

Educational Priorities

In the listing above, essential ophthalmic knowledge and clinical eye care skills are marked with a single asterisk *. This material is basic for all international medical student education.

Information that reflects a greater level of understanding is marked with two asterisks**.

Areas of cognitive and clinical skills that are more appropriate for students who seek further training in ophthalmology are marked with three asterisks***.

While important to ophthalmic care, the Task Force does not regard the cognitive or skill set designated ** or *** as essential to the basic curriculum of most international medical students.

Next: 10. Intraocular Tumors

Also see:

• Introduction to the "International Curriculum Guidelines on Medical Student Education in Ophthalmology"
  
  
• Table of Contents for the Curriculum
  
  
• Education of Medical Students in Ophthalmology