J Korean Med Assoc.  2016 Jan;59(1):45-51. 10.5124/jkma.2016.59.1.45.

Anterior segment eye diseases associated with rheumatic diseases

• Hyon JY

• KMID: 2195167
• DOI: http://doi.org/10.5124/jkma.2016.59.1.45

Abstract

Rheumatic diseases are associated various extra-articular manifestations, such as eye, nerve, pericardium, and pleura. The anterior part of the eye has distinguished anatomic structure resembling synovial joints, thus it is a common site of ocular manifestation in rheumatic disease. These changes include sicca syndrome, peripheral ulcerative keratitis, episcleritis, scleritis, and iritis. Some of these findings may be the clues for the diagnosis of the rheumatic diseases, and some ocular manifestations may represent the activity or prognosis of the rheumatic diseases. These ocular complications may leads to severe visual loss. It is crucial to rule out underlying systemic diagnosis in rheumatic disease associated ocular diseases, and when diagnosed, the coordination of the rheumatologist with the ophthalmologist in the treatment is imperative.

Keyword

Rheumatic diseases; Sjogren's syndrome; Scleritis

MeSH Terms

Corneal Ulcer
Diagnosis
Eye Diseases*
Iritis
Joints
Pericardium
Pleura
Prognosis
Rheumatic Diseases*
Scleritis
Sjogren's Syndrome

Figure

• 

  Figure 1 Sicca changes in the ocular surface of Sjogren's syndrome patient with patch pattern of punctate epithelial erosion and immediate break-up of the tear film.

• 

  Figure 2 Diffuse scleritis associated with rheumatoid arthritis.

• 

  Figure 3 Nodular scleritis in a 67-year-old female seropositive rheumatoid arthritis patient.

• 

  Figure 4 Necrotizing scelritis associated with previous pterygium surgery.

• 

  Figure 5 Necrotizing scleritis without inflammation (scleromalacia perforans).

• 

  Figure 6 Peripheral ulcerative keratitis in a rheumatoid arthritis patient. Severe thinning of the peripheral cornea eventually progressed to corneal perforation.

Reference

1. Treacy O, Fahy G, Ritter T, O'Flynn L. Corneal immunosuppressive mechanisms, anterior chamber-associated immune deviation (ACAID) and their role in allograft rejection. Methods Mol Biol. 2016; 1371:205–214.

2. Hamideh F, Prete PE. Ophthalmologic manifestations of rheumatic diseases. Semin Arthritis Rheum. 2001; 30:217–241.

3. Widdifield J, Paterson JM, Bernatsky S, Tu K, Tomlinson G, Kuriya B, Thorne JC, Bombardier C. The epidemiology of rheumatoid arthritis in Ontario, Canada. Arthritis Rheumatol. 2014; 66:786–793.

4. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007; 5:75–92.

5. Shiboski SC, Shiboski CH, Criswell L, Baer A, Challacombe S, Lanfranchi H, Schiodt M, Umehara H, Vivino F, Zhao Y, Dong Y, Greenspan D, Heidenreich AM, Helin P, Kirkham B, Kitagawa K, Larkin G, Li M, Lietman T, Lindegaard J, McNamara N, Sack K, Shirlaw P, Sugai S, Vollenweider C, Whitcher J, Wu A, Zhang S, Zhang W, Greenspan J, Daniels T. Sjogren's International Collaborative Clinical Alliance (SICCA) Research Groups. American College of Rheumatology classification criteria for Sjogren's syndrome: a data-driven, expert consensus approach in the Sjogren's International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken). 2012; 64:475–487.

6. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000; 118:615–621.

7. Ngo W, Situ P, Keir N, Korb D, Blackie C, Simpson T. Psychometric properties and validation of the Standard Patient Evaluation of Eye Dryness questionnaire. Cornea. 2013; 32:1204–1210.

8. Han SB, Hyon JY, Woo SJ, Lee JJ, Kim TH, Kim KW. Prevalence of dry eye disease in an elderly Korean population. Arch Ophthalmol. 2011; 129:633–638.

9. Hyon JY, Kim HM, Lee D, Chung ES, Song JS, Choi CY, Lee J. Korean Corneal Disease Study Group. Korean guidelines for the diagnosis and management of dry eye: development and validation of clinical efficacy. Korean J Ophthalmol. 2014; 28:197–206.

10. Han SB, Hyon JY, Wee WR, Lee JH, Lee YJ, Yun PY. Reduced corneal sensitivity in patients with primary Sjogren's syndrome. Acta Ophthalmol. 2010; 88:e277–e278.

11. Hagan S, Tomlinson A. Tear fluid biomarker profiling: a review of multiplex bead analysis. Ocul Surf. 2013; 11:219–235.

12. Tong L, Thumboo J, Tan YK, Wong TY, Albani S. The eye: a window of opportunity in rheumatoid arthritis? Nat Rev Rheumatol. 2014; 10:552–560.

13. Zheng X, de Paiva CS, Li DQ, Farley WJ, Pflugfelder SC. Desiccating stress promotion of Th17 differentiation by ocular surface tissues through a dendritic cell-mediated pathway. Invest Ophthalmol Vis Sci. 2010; 51:3083–3091.

14. Tan X, Sun S, Liu Y, Zhu T, Wang K, Ren T, Wu Z, Xu H, Zhu L. Analysis of Th17-associated cytokines in tears of patients with dry eye syndrome. Eye (Lond). 2014; 28:608–613.

15. Hyon JY, Lee YJ, Yun PY. Management of ocular surface inflammation in Sjogren syndrome. Cornea. 2007; 26:9 Suppl 1. S13–S15.

16. Markovitz E, Perry ZH, Tsumi E, Abu-Shakra M. Ocular involvement and its' manifestations in rheumatoid arthritis patients. Harefuah. 2011; 150:713–718. 751

17. Jeon HS, Hyon JY, Kim MK, Chung TY, Yoon KC, Kim JY, Na KS, Kim HJ, Kim TI, Lee JS, Lee HK, Song JS. Efficacy and safety of immunosuppressive agents in the treatment of necrotising scleritis: a retrospective, multicentre study in Korea. Br J Ophthalmol. 2015; [Epub]http://dx.doi.org/10.1136/bjophthalmol-2015-307462.

18. Ahn SJ, Oh JY, Kim MK, Lee JH, Wee WR. Clinical features, predisposing factors, and treatment outcomes of scleritis in the Korean population. Korean J Ophthalmol. 2010; 24:331–335.

19. Murphy CC, Ayliffe WH, Booth A, Makanjuola D, Andrews PA, Jayne D. Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis. Ophthalmology. 2004; 111:352–356.

20. Suhler EB, Lim LL, Beardsley RM, Giles TR, Pasadhika S, Lee ST, de Saint Sardos A, Butler NJ, Smith JR, Rosenbaum JT. Rituximab therapy for refractory scleritis: results of a phase I/II dose-ranging, randomized, clinical trial. Ophthalmology. 2014; 121:1885–1891.

21. Yokogawa H, Kobayashi A, Yamazaki N, Masaki T, Sugiyama K. Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital. Clin Ophthalmol. 2014; 8:2165–2170.

22. Foster CS, Forstot SL, Wilson LA. Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis: effects of systemic immunosuppression. Ophthalmology. 1984; 91:1253–1263.

23. Artifoni M, Rothschild PR, Brezin A, Guillevin L, Puechal X. Ocular inflammatory diseases associated with rheumatoid arthritis. Nat Rev Rheumatol. 2014; 10:108–116.

24. Llorenc V, Mesquida M, Sainz de la Maza M, Keller J, Molins B, Espinosa G, Hernandez MV, Gonzalez-Martin J, Adan A. Epidemiology of uveitis in a Western urban multiethnic population: the challenge of globalization. Acta Ophthalmol. 2015; 93:561–567.

25. Pinckers A, Broekhuyse RM. The EOG in rheumatoid arthritis. Acta Ophthalmol (Copenh). 1983; 61:831–837.

26. Clarke AK. Antimalarial drugs in the treatment of rheumatological diseases. Br J Rheumatol. 1998; 37:580.