Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.

OBJECTIVE: To evaluate the frequency and characteristics of ocular manifestations in outpatients with systemic sclerosis. METHODS: In this cross-sectional study, 45 patients with systemic sclerosis were enrolled. Data regarding demographics, disease duration and subtype, age at diagnosis, nailfold capillaroscopic pattern and autoantibody profile were collected, and a full ophthalmic examination was conducted. Parametric (Student's t-test) and nonparametric (Mann-Whitney U test) tests were used to compare continuous variables. Fisher's exact test was used to compare categorical data. P values < 0.05 were considered significant. RESULTS: Twenty-three subjects (51.1%) had eyelid skin changes; 22 (48.9%) had keratoconjunctivitis sicca, 19 (42.2%) had cataracts, 13 (28.9%) had retinal microvascular abnormalities and 6 (13.3%) had glaucoma. Eyelid skin changes were more frequent in patients with the diffuse subtype of systemic sclerosis and were associated with a younger age and an earlier age at diagnosis. Cataracts were presumed to be age-related and secondary to corticosteroid treatment. There was no association between demographic, clinical or serological data and keratoconjunctivitis sicca. The retinal microvascular abnormalities were indistinguishable from those related to systemic hypertension and were associated with an older age and a severe capillaroscopic pattern. CONCLUSIONS: Eyelid skin abnormalities and keratoconjunctivitis sicca were the most common ocular findings related to systemic sclerosis. Some demographic and clinical data were associated with some ophthalmic features and not with others, showing that the ocular manifestations of systemic sclerosis are characterized by heterogeneity and reflect the differences in the implicated pathophysiological mechanisms.

HIV/AIDS affects millions of people worldwide. In the early stages of epidemic, eyes were affected because the CD4 T-lymphocytes count of HIV-infected patients dropped rapidly. Today, with the advent of highly active antiretroviral therapy, HIV-positive individuals live longer with a better quality of life. However, because a cure has not been found, many patients with HIV will develop ocular complications at some point. Ophthalmologists play an important role in the care of these patients. We must be prepared to work as part of a multidisciplinary staff, helping to understand the causes and try to achieve the best management of disease in order to prevent blindness. Most HIV-related ocular manifestations are discussed in this article, with a review of studies within the past 2 years. We hope government authorities, pharmaceutical industries, researchers and people from all nations stand together with two goals--less suffering and definitive cure.

CXL with riboflavin and UV-A improved CS and inhibited the progression of keratoconus. As a predictor of treatment efficacy, eyes with CKA showed greater improvement in BSCVA after CXL when compared with eyes with PKA.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect different ocular structures, such as cornea, conjunctiva, episclera, sclera, uveal tract, retina, optic nerve and vessels. Neuro-ophthalmologic manifestations in SLE include different degrees of involvement of retina, choroid and optic nerve. Retinal changes are one of the most common ocular involvements and are frequently used as clinical criteria for activity, even if isolated. Studies show that up to 29% of patients with active SLE manifest retinal disease. The exact prevalence of choroidal disease is unknown, but is thought to be less common than retinopathy, due to under-diagnosis. Optic nerve disease, represented by optic neuritis and anterior/posterior ischaemic optic neuropathy, affects approximately 1% of SLE patients. These ocular manifestations have been associated with neurologic flares, antiphospholipid antibodies, nephropathy, and increased mortality. The aim of this paper is to review the different aspects of neuro-ophthalmologic involvement in SLE. Since these manifestations are frequent and potentially severe, a multi-professional team approach is needed to investigate properly and provide early aggressive treatment in order to avoid visual sequelae.

Dr. Santhiago is a consultant to Ziemer Ophthalmic Systems AG and Alcon Laboratories, Inc. None of the authors has a financial or proprietary interest in any material or method mentioned.

OBJECTIVES:The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients.METHODS:We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear break-up time and rose bengal). Demographic parameters were also evaluated.RESULTS:The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%), and the majority had polyarticular disease (57.5%). Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group.CONCLUSIONS:In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.

Physicians should be aware of the possibility of eye inflammation following the yellow fever vaccination.