Ocular findings in patients with systemic sclerosis

Gomes, Beatriz de Abreu Fiuza; Santhiago, Marcony R.; Magalhães, Priscilla de Andrade; Kara-Júnior, Newton; Azevedo, Mário Newton Leitão de; Moraes, Haroldo Vieira de

doi:10.1590/s1807-59322011000300003

Cited by 78 publications

(73 citation statements)

References 56 publications

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“…2 The most common ocular findings are keratoconjunktivitis sicca, eyelid skin fibrosis, anterior uveitis, normal tension glaucoma, optic neuropathy, and choroidopathy. [3][4][5][6] Choroid is a vascular structure of the eye that supplies oxygen and metabolites to the outer segment of the retina. 7 Enhanced depth imaging optical coherence tomography (EDI-OCT) technologies provide accurate quantitative analysis of the choroid tissue.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of choroidal thickness in patients with scleroderma

Coşkun

Zengin

Kenan

et al. 2016

Eye

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Purpose To investigate the choroidal thickness in patients with scleroderma and to compare them with healthy control subjects. Methods Forty-six patients with scleroderma (3 male and 43 female) and 31 healthy controls (6 male and 25 female) were included in the study. Twenty-five patients had limited-type and 21 patients had diffuse-type scleroderma. Only left eyes of the patients and control subjects were used in the analysis. Demographic features of all the patients and control subjects were recorded. Each subject underwent ophthalmological examinations including refraction, visual acuity, intraocular pressure, axial length (AXL) measurement, slit-lamp biomicroscopy, and fundus examination. Body mass index (BMI) was estimated for all participants. Results There were no significant differences between the patients with scleroderma and the control subjects in terms of age, gender, BMI, mean AXL, and mean spherical equivalent refractive error (SE) (P = 0.1, P = 0.086, P = 0.37, P = 0.55, and P = 0.072 respectively). The patients with scleroderma had significantly thinner nasal, temporal, and subfoveal choroid than the healthy control subjects (P 1 = 0.012, P 2 = 0.046, and P 3 o0.001, respectively). There were no significant differences between the patients with limited-type and diffuse-type scleroderma in terms of age, gender, BMI, mean AXL, mean SE, nasal, temporal, and subfoveal choroidal thicknesses (all P40.05). Conclusions Choroidal thickness in patients with scleroderma was significantly less than healthy control subjects. Vasculopathy in scleroderma is characterized by obliteration of arterioles and reduced capillary density may cause atrophy of choroid in patients with scleroderma.

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Section: Introductionmentioning

confidence: 99%

Evaluation of choroidal thickness in patients with scleroderma

Coşkun

Zengin

Kenan

et al. 2016

Eye

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“…One of the most frequent ocular features of SSc is dry eye disease (DED), which has been identified to occur in 37-79% of patients and is thought to be derived from fibrosis of the conjunctiva and lacrimal gland, which leads to a tear deficiency state that causes further damage to the ocular surface [4,5]. Although the probability of dry eye causing blindness or visual impairment is low, it has a significant impact on the daily and social lives of patients [6,7].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of dry eye signs and symptoms in patients with systemic sclerosis

Gomes

Santhiago

Azevedo

et al. 2012

Graefes Arch Clin Exp Ophthalmol

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Background One of the most frequent ocular features of systemic sclerosis (SSc) is dry eye disease (DED), which has been identified to occur in 37-79% of patients.Although several studies have found weak or no correlations between symptoms and signs of dry eye, symptoms are often the motivation for seeking eye care, and are therefore a critical outcome measure when assessing treatment effect. The aim of this study is to evaluate the impact of symptoms of dry eye on vision-related quality of life in patients with systemic sclerosis, and to investigate the relation between clinical tests and symptoms of dry eye in these patients. Methods In this cross-sectional study, 45 consecutive patients with SSc were enrolled. For evaluation of the symptoms the "Ocular Surface Disease Index (OSDI)" questionnaire was applied to all patients. After that, all individuals were submitted to a full ophthalmic examination, including the following tests: tear break-up time, Schirmer I, rose bengal staining. Patients were then grouped into dry eye and non-dry eye groups with regard to the diagnosis of dry eye. Mann-Whitney test was used to compare continuous variables, whereas the Fisher exact test was used to compare categorical data between groups. Spearman's correlation test was used to analyze the correlations between clinical tests and OSDI scores. P values <0.05 were considered significant. Results Dry eye disease was diagnosed in 22 patients (48.9%). Other ocular surface abnormalities found were: blepharitis (40% of the patients), pterygium (15.6%), pinguecula (82.2%), and superficial punctate keratitis (26.7%). Among the 45 patients, 29 patients (64.4%) had symptoms of ocular surface disease. The mean OSDI score was 26.8±25.8 (SD). There were no statistically significant differences in OSDI scores between DED and non-DED patients. No substantive correlations were found between OSDI scores and TBUT, Schirmer I, or rose bengal staining score, and none of the observed correlations reached statistical significance. Conclusion Symptoms of dry eye have a moderate impact on vision-related quality of life in patients with systemic sclerosis and do not correlate well with clinical findings.

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“…On the other hand, the frequency of eyelid skin changes is expected to be different in ssSSc patients due to the absence of skin thickening, but no prevalence studies are known. In the previous study, recurrent episcleritis was reported (4.4%), but other inflammatory diseases, including scleritis, peripheral ulcerative keratitis and uveitis, were not (13). To our knowledge, there are only four case reports in the literature pointing to a rare association between SSc and uveitis in adults, since this relationship is more established in pediatric scleroderma (9,14).…”

Section: N Discussionmentioning

confidence: 85%

“…In a cross-sectional study of 25 patients, eyelid skin changes were present in the majority (51.1%), keratoconjunctivitis sicca in almost half (48.9%), cataracts in 42.2%, retinal microvascular abnormalities (indistinguishable from those related to systemic hypertension and often associated with a severe capillaroscopic pattern) in 28.9%, glaucoma in 13.3% and conjunctival vascular congestion in 8.9% (13). Furthermore, microcirculation seems to be affected early in the course of the disease, with significant reduction of choroidal perfusion (8).…”

Section: N Discussionmentioning

confidence: 99%

Systemic sclerosis sine scleroderma: a case report of anterior uveitis

Borges¹,

Vilaça²,

Ferreira³

et al. 2015

Reumatismo

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Systemic sclerosis (SSc) sine scleroderma (ssSSc) is characterized by the absence of skin involvement, despite other manifestations of systemic sclerosis are present. It is not known whether sSSc represents a <em>forme</em> <em>fruste</em> of limited cutaneous SSc or a distinct entity, but the 2013 American College of Rheumatology/European League Against Rheumatism criteria for the classification of SSc have considered SSc without skin involvement to be a distinct subset. The authors present the case of a 70-year old female that was referred for a consultation for Raynaud’s phenomenon and a chronic anterior uveitis (CAU). She had a history of dysphagia, diffuse pulmonary emphysema and a biopsy-documented fibrosis of the upper lobes, and an idiopathic non-ischemic dilated cardiomyopathy with severe left ventricle systolic dysfunction and left bundle branch block. Anti-nuclear and anti-centromere antibodies were positive, while manometry revealed distal esophageal hypomotility. After establishing the diagnosis of ssSSc and starting immunosuppression, the ocular disease improved, while the lung and heart diseases remained stable. This case underlines that it is very important to suspect SSc when CAU is present and/or skin thickening is absent. To our knowledge, this is the first report of CAU in a patient with ssSSc.

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Ocular findings in patients with systemic sclerosis

Cited by 78 publications

References 56 publications

Evaluation of choroidal thickness in patients with scleroderma

Evaluation of choroidal thickness in patients with scleroderma

Evaluation of dry eye signs and symptoms in patients with systemic sclerosis

Systemic sclerosis sine scleroderma: a case report of anterior uveitis

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