FRI0253 OCULAR MANIFESTATIONS IN PATIENTS WITH SYSTEMIC SCLEROSIS
Authors: D. Monova, S. Monov, D. Dimova, V. Tzankov, M. Sotirova
Journal: Annals of the Rheumatic Diseases (2020)

Background: Systemic sclerosis (SSc) is a connective tissue disease with heterogeneous manifestations. It affects different organs and therefore requires interdisciplinary diagnostic and therapeutic management. Objectives: The aim of this study is to evaluate the frequency and characteristics of ocular manifestation in patients with systemic sclerosis. Methods: The study involved 31 patients with SSc. All the study subjects underwent complete ophthalmological examination involving visual acuity assessment, examination of anterior and posterior eye segments, Schirmer I test, diameter and mobility of pupils, as well as eyeball mobility assessment of intraocular pressure and ultrasound assessment of vitreous body. Data regarding age, gender, SSc subtype, disease duration, age at diagnosis, nailfold capillaroscopic pattern, systemic corticosteroid or chloroquine use, blood pressure, ocular symptoms and detailed ophthalmic history were recorded. Results: 31 patients (3 male, 28 female, mean age 42,7 ± 14,3 years; mean disease duration 10,3±8,1 years) were enrolled in this study. 7 (22,58 %) of them had no ocular symptoms. Among the patients with ocular symptoms, 20 (64.52%) complained of decreased vision, 13 (41,93 %) - of itching, 14 (45,16%) - of burning, 8 (25,81%) - of eye fatigue,4 (12,90 %) - of ocular pain, 4 (12,90%) - of foreign body sensation, 16 (51,61 %) - of dry eye, 5 (52,03 %) -photophobia, 2 (6,45 %) - of floaters, 10 (32,26 %) - of redness. Hardening and thickening of palpebral skin was noted in 27 (87,10 %) patients. Ophthalmological examination revealed higher incidence of the following abnormalities in the study group: myopic astigmatism - in 20 (32,26 %) eyes, vascular abnormalities within fundus - in 24 (38,71%) eyes, increased intraocular pressure (&gt; 21 mm Hg) - in 13 (20,97%) eyes. Mean IOP values were 18,21 ±4,2 mm Hg.Eyelid telangiectasias was noted in 9 (29,03 %) patients, chronic blepharitis - in 13(41,94 %). Lens opacity was found in 16 (51,61 %) patients (27 eyes), mostly in the form of posterior subcapsular cataract (in 20 eyes), nuclear cataract (in 6 eyes) and cortical cataract appearing as focal cystic opacities (in 1 eye). The mean age of patients with cataracts was 49,2 ± 12,3 years (11,4 years older than patients without cataracts). Additionally, 14 of the patients with cataracts were either currently taking or had previously taken systemic corticosteroids. Superficial conjunctival hyperaemia was noted in 20 (64,52 %), and varicose dilatation of subconjunctival and episcleral blood vessels in 9 (29,03 %) and 7 (22,58 %) patients, respectively. In 9 eyes (14,52 %) foci of pigment epithelium were found peripherally on the optic disc, In 6 (9,68 %) eyes - thinning of choroidal capillaries and retinal pigment epithelium, in 8 (12,90 %) - ischemic areas surrounded by microaneurysms and intraretinal extravasation, dilatation of the vessel-free fovea. сonjunctival fibrosis - in 8 (25,81 %) patients. In 25 eyes Schirmer I test results were below 10 mm, and in 7 eyes - below 5 mm. Eyelid stiffness was associated with difficulty in lid eversion and a woody texture upon palpation. Comparing patients with and without eyelid stiffness, we found that the mean age and the age at diagnosis were significantly lower in the former group (p &lt; 0.01 and p &lt; 0.05, respectively). The diffuse subtype was more prevalent among pts with eyelid skin changes (p &lt; 0,05). Conclusion: In patients with SSc numerous abnormalities within the vision of organ may be found. Ocular symptoms are relatively common complications of SSc, and may result in serious, irreversible changes in the organ of vision. Regular ophthalmological examinations are essential among the patients with SSc. Disclosure of Interests: None declared