A Wide Spectrum of Ocular Manifestations Signify Patients with Systemic Sclerosis

Abstract

Objectives: Systemic sclerosis (SSc) is a rare, chronic connective tissue disease involving multiple organ systems, including the eye. We evaluated the detailed clinical ocular manifestations of outpatients with SSc. Methods: Demographics, disease duration and subtype, nailfold capillaroscopy (NFC) patterns and laboratory parameters encompassing the autoantibody profile of 51 SSc patients were evaluated, and a general ocular examination was performed for each participant. Results: Twenty-nine patients (56.86%) had eyelid skin alterations, 26 (50.98%) had retinal abnormalities, 26 (50.98%) had cataracts, 8 (15.69%) had conjunctival changes, 7 (13.73%) had iris abnormalities, 33 (64.71%) suffered from dry eye disease (DED), and 11 (21.57%) suffered from glaucoma. Significant positive correlations were found between NFC data and both tear breakup time and Ocular Surface Disease Index test values. Conclusions: Eyelid skin abnormalities, DED and retinal abnormalities are among the most common SSc-related ocular involvements. Diverse ophthalmic findings are attributed to the heterogeneity of SSc.

Prevalence of retinal changes in patients with systemic sclerosis: the association between retinal vascular changes and nailfold capillaroscopic findings

“…Ushiyama et al [ 12 ] reported a prevalence of 8% in the control group. In a recent study performed by Szucs et al [ 22 ] 58.9% of the patients had retinal and choroid changes found in the photography of the fundus.…”

“…Ushiyama et al [ 12 ] reported higher systolic blood pressure and age in the group of scleroderma patients in comparison to the control group. Szucs et al [ 22 ] did not exclude hypertensive patients. In our study, we excluded patients with diabetes mellitus and smokers, and we did not have any patient with a history of hypertensive crisis.…”

Evaluation of the optic nerve head vessel density in patients with limited scleroderma

“…Gomes and colleagues 3 found the prevalence of glaucoma to be 13.3% (11.1% POAG, 2.2% angle closure glaucoma) but did not investigate for NTG and suggested that systemic vascular disturbances were a potential reason for its occurrence. In a recent study, Szucs and colleagues 4 investigated glaucoma detection based on different diagnostic techniques including IOP measurement, peripapillary RNFL thickness, and automated static perimetry, and they found that approximately one-fifth (21.57%) of the patients suffered from a wide spectrum of glaucoma types including POAG, closed-angle, pigmentary, and NTG. These studies all suggested a glaucomatous propensity and justified long-term follow-up of scleroderma patients to assess the ophthalmological risk.…”

“…The higher risk of glaucoma in scleroderma patients is often attributed to generalized vasospasm, which is one of the main features of scleroderma. 1 – 5 In addition to vasospasm, ischemic changes and local infarction, which are thought to be involved in the pathogenesis of scleroderma, can also increase the risk of glaucoma. 6 , 7 If these ischemic changes and infarction occur in the optic nerve head and peripapillary retina as mentioned above, they may be the main cause of glaucoma predisposition.…”

Dry Eye in Systemic Sclerosis Patients: Novel Methods to Monitor Disease Activity

“…Dry eye syndrome (DES) is a dysfunction of the tears and the ocular surface; it is very common and complex, affecting 5-50% of patients, giving rise to symptoms of discomfort, visual disturbances, and tear instability due to an increase in tear osmolarity and the inflammation of the ocular surface [8,9]. Due to increases in video terminal syndrome and office eye disease syndrome, the prevalence of DES rises annually.…”