Ophthalmic Findings in Systemic Sclerosis and Its Association with Dermal Fibrosis

Abstract

Objective: To determine frequency and type of ophthalmologic findings in Systemic Sclerosis (SSc) and to establish their association with the extent and severity of cutaneous fibrosis. Methods: Descriptive-transversal study of 34 patients, (January-December 2017). It included patients with limited cutaneous Systemic Sclerosis (lcSS) and diffuse cutaneous Systemic Sclerosis (dcSS). The severity of cutaneous fibrosis was measured using the modified Rodnan skin score (mRSS). The ophthalmologic examination consisted of the evaluation of the palpebral fibrosis and the ocular surface by Schirmer's test, tear rupture time (BUT), OSDI (Ocular Disease Surface Index) and SANDE (Symptom Assessment in Dry Eye) questionnaires, eye fundus and retinography. We use simple logistic regression (OR) to establish the association with p < 0.05. Results: 21 patients (61.7%) with dcSS and 13 patients (38.2%) with lcSS. Women 32 (94.1%). Mean disease time 67.4 months. The mRSS was mild in 10 (29.4%) and moderate-severe in 24 (70.6%). The main findings: palpebral fibrosis 30 (88.2%), keratoconjunctivitis sicca (KCS) 26 (76.5%), blepharophimosis 20 (58.8%) and enophthalmos 7 (20.6%) had alteration of the retinal pigment epithelium 3 (8.8%). Associated with the extension: blepharophimosis, enophthalmos and KCS predominated in dcSS with Schirmer test positive in 52.4%, mild dry eye highlighted in both groups. We found significant association between blepharophimosis and moderate-severe mRSS. Conclusion: Eyelids skin thickening and KCS were more prevalent in dcSS. Moderate-severe mRSS was associated with atrophic changes in the eyelids.