Immunosuppressives in uveitis. A preliminary report of experience with chlorambucil

Ocular manifestations of vasculitis

Systemic necrotizing vasculitis is characterized by inflammation of blood vessels and often affects the eyes. Ocular manifestations of vasculitis may involve any part of the eye or orbit. The frequency of ocular involvement generally is dependent on the size and type of blood vessels affected by the vasculitis. This article reviews the major types of ocular inflammation and then addresses the ocular manifestations of specific systemic vasculitides.

Ophthalmologic manifestations of rheumatic diseases

OBJECTIVES

Detailed review of the manifestations of eye involvement in the context of rheumatic diseases.

METHODS

An OVID Medline search of the rheumatology and ophthalmology English literature related to the eye manifestations of human rheumatic diseases from 1966 to the present was conducted by the authors.

RESULTS

Analysis of 300 recent and consecutive rheumatology consultations from a large Veterans Administration Healthcare System shows that 4% are referred for eye manifestations of suspected rheumatic diseases, most commonly, anterior uveitis and keratoconjunctivitis sicca (KCS). Ocular involvement is common in the rheumatic diseases but varies among the different disorders. A literature review indicated that the most common ocular manifestations of rheumatic diseases include keratoconjunctivitis sicca, anterior uveitis, and scleritis. The most serious eye complications of the inherited connective tissue disorders are lens involvement with cataract formation or subluxation. 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. Although many of the eye manifestations are easily recognizable, consultation with an ophthalmologist is usually necessary for optimal treatment and prevention of complications.

CONCLUSIONS

The rheumatologist, in coordination with the ophthalmologist, can play a major role in detecting and managing the eye involvement in his patients to save this important sense. Understanding the varied manifestations of eye disease will permit the rheumatologist to better evaluate the activity of the rheumatic disease.

Treatment and visual prognosis in Behçet's disease

For the last decade we have observed and regularly followed 49 patients with the ocular type of Behçet's disease. Thirty-six patients were males and 13 were females. Regardless of whether the initial ocular presenting symptoms were in the anterior or posterior segment, both segments were involved within two years. Sterile hypopyon was recorded in 17 out of the 49 patients during the process of follow-up. In three of the patients hypopyon was the presenting symptom. Characteristically there was a lack of corneal or scleral involvement in the disease process. All patients responded initially to treatment with steroids, but 42 had a course of treatment with cytotoxic-immunosuppressive drugs for various lengths of time after 'resistance' to steroids developed. Although definitely effective in reducing the intensity of the ocular inflammatory processes, it is not clear yet whether these modes of treatment have any dramatic effect of the visual prognosis of the affected eyes. Despite intensive follow-up and treatment, loss of useful visual acuity has occurred in 74% of the eyes six to 10 years after the start of the ocular symptoms.

Steroids and the eye--indications and complications

Corticosteroid therapy is of great value in many types of eye disease. The indications are briefly discussed, together with the choice of agent and mode of administration. The dangers of steroids are now widely recognized, and the complications are discussed, particularly cataract and glaucoma. Reference is also made to optic neuritis and thyroid ophthalmopathy, where the role of steroids is uncertain. Particular stress is laid on the need to keep steroid dosage as low as possible, so as to avoid systemic side effects. There are unfortunately many situations where treatment of doubtful efficacy has produced severe side effects. Despite the overall benefit of steroids in ophthalmology, there is a pressing need to find alternative treatment for a variety of blinding disorders.