Abstract

Background: Autoimmune connective tissue disorder (ACTD) are chronic, inflammatory diseases, with very a broad and varied clinical presentation. Due to the generalized and chronic nature the disease influences all aspects of patient’s quality of life. Ocular involvement may be an early and sometimes presenting manifestation in some cases of ACTD. Ocular changes have an adverse effect on quality of life. The severity of ocular involvement may also be an indicator of severity of systemic disease activity and may warrant a more detailed investigation of visceral involvement. This study aimed at recording the prevalence of ocular manifestations in different ACTDs and to assess the utility of a novel technique like OCT in assessing the posterior segment involvement. Material and methods: We conducted a cross-sectional observational study in a tertiary care hospital in North India. Patients attending Dermatology outpatient and admitted in ward were recruited and subjected to a thorough evaluation. This included a complete history, a complete physical examination including general physical examination and mucocutaneous examination. Relevant hematological and biochemical investigations, skin biopsy for histopathology for hematoxylin and eosin staining, direct immunofluorescence and muscle biopsy, when indicated. A detailed Ophthalmological evaluation was done including visual acuity, Color vision, Tests for dry eye, Slit lamp examination, Ocular surface staining with fluorescein, Intraocular pressure by applanation tonometry, Detailed Fundus examination, Retinoscopy, Fluorescein angiography, if indicated, Optical coherence tomography. Results: In our study population, 22(64.7%) patients had Systemic Sclerosis, 11(32.4%) had SLE and 1 patient had Dermatomyositis. Ocular involvement was seen in 41.2% patients. Anterior segment involvement (29.4%) was more common than posterior segment involvement (11.7%). Eye lid changes were the most common finding (26.4%), followed by Glaucoma (17.6%). Decreased central macular thickness (CMT) was the most common posterior segment abnormality (8.82%). Ocular involvement was seen in 12 systemic sclerosis patients (54.54%) (n=22) whereas 2 patients (18.18%) had ocular involvement in the SLE subgroup (n=11.In SSc patients, anterior segment abnormalities included eyelid stiffness (40.9%), ciliary madarosis (27.27%), glaucoma (27.27%), dry eye (9.09%) and anterior uveitis (4.54%). Posterior segment abnormalities included central macular thinning (13.63%) and retinal arteriolar attenuation (4.54%). In SLE subgroup, only 2 patients (18.18%) had ocular involvement in the form of posterior subcapsular cataract and decreased visual acuity. Conclusion: We recommend that patients with ACTD should be actively assessed for ocular involvement and a complete ocular examination should be routinely performed as it can have an impact on the disease severity and quality of life in patients with ACTD. Optical Coherence Tomography (OCT) is a non-invasive diagnostic technique that renders an in vivo cross-sectional view of the retina. Individual retinal layers can be visualized and calculation of the retinal thickness at the centre of the macula (central macular thickness [CMT]) can be done. Thus. OCT may aid in early detection of posterior segment involvement.