Introduction: Ocular manifestations in scleroderma include many clinical presentations. A limitation in generalizing these findings to a broader patient population is evident. We aimed to study the prevalence, type, and characteristics of eye involvement in a sample of scleroderma patients in Syria. Methods: This cross-sectional study collected and analyzed demographic data regarding age, sex, smoking, alcohol use, disease duration, age at diagnosis, clinical symptoms, and physical examination, including ocular examination. Laboratory tests, including the autoantibody profile (antinuclear, anti-topoisomerase I, and anti-centromere antibodies), as well as treatment details such as systemic steroids, hydroxychloroquine, immunosuppressants, and biologics, were also evaluated. All study subjects underwent a complete ophthalmological examination by the same ophthalmologist, which was conducted for all patients and involved visual acuity assessment using Snellen’s chart, slit-lamp examination, and fundus examination after ocular surface evaluation. Additionally, anterior and posterior eye segment examinations, Schirmer’s test, pupil mobility and diameter assessments, as well as intraocular pressure evaluations, were performed. Results: One hundred and six patients were enrolled in our study, with a mean age of 39.8 ± 9.1 years (range: 23–72), and female patients comprised 92 (86.79%). The mean disease duration was 11.1 ± 7.9 years. Sixty (56.60%) of the patients had limited scleroderma. Fifty-two of these patients had been treated with methotrexate (7.5–12.5 mg/week). 64.15% of patients had ocular symptoms. 11.76 % complained of ocular pain, 23.5% reported decreased vision, 13.23% reported itching, and others reported different symptoms. Seventy-five (83.82%) patients had best-corrected visual acuity (BCVAs) of 20/30 or better. Six (8.82%) patients had BCVAs of 20/80 or worse in either eye. Bilateral low visual acuity was observed in four patients and was caused by cataracts. We did not find any differences in decreased vision related to patients’ age, disease duration, scleroderma subtype, or treatment type. No statistical differences in the analyzed variables were found between patients with keratoconjunctivitis and those without. Patients with cataracts were significantly older than those without. Discussion: The prevalence of ocular manifestations differs according to studies, ranging from 37.4% to 72.28%. Excess deposition of type I collagen in the dermis is responsible for lid stiffness, blepharophimosis, or lagophthalmos. Previously, a relationship was found between Sicca syndrome and anti-Ro antibodies in patients with scleroderma. Some ocular manifestations, such as uveitis, episcleritis, scleritis, and peripheral ulcerative keratitis, were previously reported in patients with scleroderma. Pen-angle glaucoma was found in 10.29% of some studies. Microvascular changes, retinal and optic nerve edema or hemorrhages, cotton-wool spots, exudates, cystoid bodies, and retinal vascular occlusion were associated with advanced systemic sclerosis (SSc), especially in patients with renal involvement and in the presence of hypertension. Cataract was found in patients under treatment with systemic corticosteroids. Conclusion: The heterogeneity marked the ocular presentation in scleroderma. The abnormalities of the eyelid skin and keratoconjunctivitis were the most frequent eye manifestations. Patients with scleroderma may also develop ocular abnormalities due to their therapy. This study revealed the importance of routine ophthalmologic screening in SSc patients. Although the sample size, when calculated, was sufficient to detect the difference, large multicenter studies are recommended to generalize our results and recommendations in Syrian patients with SSc. There is a justifiable need for local Syrian data on ocular complications of SSc.
Kudsi et al. (Fri,) studied this question.