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%), keratocon-junctivitis 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.
Cite this paper
Villegas, J. and Yánez, B. (2019). Ophthalmic Findings in Systemic Sclerosis and Its Association with Dermal Fibrosis. Open Access Library Journal, 6, e5672. doi: http://dx.doi.org/10.4236/oalib.1105672.
Barsotti, S., Stagnaro, C. and Della Rossa, A. (2015) Systemic Slerosis: A Critical Digest of the Recent Literature. Clinical Ex-perimental Rheumatology, 33, S3-S14.
Tailor, R., Gupta, A., Herrick, A. and Kwartz, J. (2008) Ocular Manifestations of Scleroderma. Survey of Ophthalmology, 54, 292-304. https://doi.org/10.1016/j.survophthal.2008.12.007
West, R.H. and Barnett, A.J. (1979) Ocular Involvement in Scleroderma. British Journal of Ophthalmology, 63, 845-847. https://doi.org/10.1136/bjo.63.12.845
Waszczykowska, A., Gos, R., Waszczykowska, E., Dziankowska-Bartkowiak, B. and Jurowski, P. (2013) Prevalence of Ocular Manifestations in Systemic Sclerosis Patients. Archives of Medical Science, 9, 1107-1113. https://doi.org/10.5114/aoms.2013.39217
Uribe Laiseca, C.M. (2012) Manifestaciones oculares de esclerosis sistémica: Estudio de casos y controles. Tesis Universidad de Colombia, Facultad de Medicina, Bogotá. http://www.bdigital.unal.edu.co/11351/1/5598736.2012.pdf
Perez, M.C. (2015) Esclerosis Sistémica en pacientes colombianos. Experiencia de un centro y revisión de la literatura. Tesis, Universidad CES, Antioquia. http://hdl.handle.net/10946/4225
Ushiyama, O., Ushiyama, K., Yamada, T., Koarada, S., Tada, Y., et al. (2003) Retinal Findings in Systemic Sclerosis: A Comparison with Nailfold Capillaroscopic Patterns. Annals of the Rheumatic Diseases, 62, 204-207. https://doi.org/10.1136/ard.62.3.204
Rodnan, G.P., Lipinski, E. and Luksick, J. (1979) Skin Thickness and Collagen Content in Progressive Systemic Sclerosis and Localized Scleroderma. Arthritis & Rheumatology, 22, 130-140. https://doi.org/10.1002/art.1780220205
Gulati, A., Sullivan, R., Buring, J.E., Sullivan, D.A. and Schaumberg, D.A. (2006) Validation and Repeatability of a Short Questionnaire for Dry Eye Syndrome. American Journal of Ophthalmology, 142, 125-131. https://doi.org/10.1016/j.ajo.2006.02.038
Varga, J. and Abraham, D. (2007) Systemic Sclerosis: A Prototypic Multisystem Fibrotic Disorder. Journal of Clinical Investigation, 117, 557-567. https://doi.org/10.1172/JCI31139
Czirjak, L., Foeldvari, I. and Muller-Ladner, U. (2008) Skin Involvement in Systemic Sclerosis. Rheumatology, 47, 44-45. https://doi.org/10.1093/rheumatology/ken309
Furst, D.E., Clements, P.J., Steen, V.D., Medsper, T.A., Masi, A.T., et al. (1998) The Modified Rodnan Skin Score Is an Accurate Reflection of Skin Biopsy Thickness in Systemic Sclerosis. The Journal of Rheumatology, 25, 84-88.
Rentka, A., Nagy, A., Harsfalvi, J., Szucs, G., Szekanecz, Z., et al. (2017) Association between Objective Signs and Subjective Symptoms of Dry Eye Disease in Patients with Systemic Sclerosis. Rheumatology International, 37, 1835-1845. https://doi.org/10.1007/s00296-017-3794-2
Gomes, B.A.F., Santhiago, M.R., de Azevedo, M.N. and Moraes, H.V. (2012) Evaluation of Dry Eye Signs and Symptoms in Patients with Systemic Sclerosis. Graefe’s Archive for Clinical and Experimental Ophthalmology, 250, 1051-1056. https://doi.org/10.1007/s00417-012-1938-3
Ayhan, Z., Kaya, M., Ozturk, T., Arikan, G. and Birlik, M. (2018) Association between Skin Thickness Measurements with Corneal Biomechanical Properties and Dry Eye Tests in Systemic Sclerosis. Ocular Immunology and Inflammation, 1-6. https://doi.org/10.1080/09273948.2018.1501496
Kreps, E.O., Carton, C., Cutolo, M, Cutolo, C.A., Vanhaecke, A., et al. (2019) Ocular Involvement in Systemic Sclerosis: A Systemic Literature Review, It’s Not All Scleroderma That Meets the Eye. Seminars in Arthritis and Rheumatism, 49, 119-125. https://doi.org/10.1016/j.semarthrit.2018.12.007
