J Rheum Dis.  2013 Jun;20(3):149-155. 10.4078/jrd.2013.20.3.149.

Eye and Rheumatic Disease

• Kim YJ
• Lee JY

• KMID: 2222753
• DOI: http://doi.org/10.4078/jrd.2013.20.3.149

Abstract

Rheumatic disorders commonly affect the sclera, cornea, retina, and orbit. These disorders range from relatively mild ocular surface problems to a serious threat for the visual sight. The most common ocular manifestations of rheumatic diseases include keratoconjunctivitis sicca, anterior uveitis, and scleritis. The most common entities to causing anterior uveitis and scleritis are seronegative spondyloarthropathies associated with human leukocyte antigen (HLA)-B27 and rheumatoid arthritis, respectively. Patients who developed bilateral or recurrent uveitis, or who have involvement of posterior ocular structures are more likely to have underlying systemic inflammatory diseases. The most significant side effects of the drugs used to treat rheumatic diseases are the maculopathy-associated with anti-malarial agents and cataracts and glaucoma associated with corticosteroid use. Close collaborations between ophthalmologists and rheumatologists are necessary for optimal treatments and the prevention of complications. Understanding the range and patterns of ocular manifestations of rheumatic diseases can provide valuable suggestions for the most suitable diagnosis and optimal management for these patients.

Keyword

Rheumatic diseases; Ocular manifestations

MeSH Terms

Arthritis, Rheumatoid
Cataract
Cooperative Behavior
Cornea
Eye
Glaucoma
Humans
Keratoconjunctivitis Sicca
Leukocytes
Orbit
Retina
Rheumatic Diseases
Sclera
Scleritis
Spondylarthropathies
Uveitis
Uveitis, Anterior

Figure

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  Figure 1. (A) Anterior segment photograph of the left eye showing peripheral ulcerative keratitis combined with conjunctival involvement with dilated tortuous vessels and underlying scleromalacia in a patient with rheumatoid arthritis. (B) Photograph taken with the slit beam denoting a crescent lesion involving the nasal corneal margin from 7 to 10 o'clock in a clockwise direction was associated with corneal stromal thinning in the same patient.

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  Figure 2. (A) Fundus photograph with retinal vasculitis and retinal hemorrhage associated with branch retinal vein occlusion due to Behcet's diseases. (B) Mid-phase fluorescein angiogram demonstrating retinal vasculitis in the same patient.

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  Figure 3. (A) Posterior iridolenticular synechiae associated with chronic granulomatous anterior uveitis in a patient with sarcoidosis. (B) Fundus photograph of the same patient showing vitreous infiltration and periphlebitis called “candle-wax drippings”.

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