Most rheumatic diseases are immunological in nature, an attack on one's own tissues is produced, it is what we know as an autoimmune reaction and can affect different parts of the body, including the eyes, which is why it is important to know this association between rheumatic disorders and eye involvement.

In this article we will deal with the most frequent rheumatic and autoimmune processes that can affect the eyes as well as the form of presentation at the ocular level:

Rheumatoid arthritis

It is a systemic autoimmune disease, characterized by causing chronic inflammation mainly of the joints, which produces progressive destruction with different degrees of deformity and functional disability. Sometimes, its behavior is extra-articular and can affect various organs and systems, such as the eyes, lungs and pleura, heart and pericardium, skin or blood vessels. Although the disorder is of unknown cause, autoimmunity plays a major role in the chronic course of the disease.

At the ocular level, crises of uveitis (inflammation of the middle layer of the eye: iritis, when located anteriorly and choroiditis, when it affects the posterior region). Another form of manifestation is Episcleritis, Scleritis or the Syndrome of Dry Eye, due to involvement of the lacrimal glands and the ocular surface (cornea and conjunctiva).

Systemic lupus erythematosus

It is a chronic autoimmune disease that affects the connective tissue, characterized by inflammation and tissue damage mediated by the immune system, specifically due to the binding of antibodies to the cells of the body and the deposit of antigen-antibody complexes. It can affect any part of the body, although the most frequent sites are the reproductive system, joints, skin, lungs, blood vessels, kidneys, liver (the first organ that usually attacks) and the nervous system. The course of the disease is unpredictable, with periods of crisis alternating with remission. It is nine times more frequent in women than in men. The first manifestations of the disease are frequently observed between 15 and 44 years of age.

Ocular involvement can also be in the form of uveitisscleritis conjunctivitis o Dry Eye Syndrome.

Scleroderma

Scleroderma (“hardened skin”), also called progressive systemic sclerosis and CREST syndrome, is a diffuse connective tissue disease characterized by changes in the skin, blood vessels, skeletal muscles, and internal organs. The causes of this disease are unknown.

Scleroderma causes the connective tissue to harden and hypertrophy increasing its volume. It can also cause swelling or pain in the muscles and joints.

At the ocular level, they frequently appear conjunctivitis non-infectious diseases that are difficult to diagnose, as well as ocular dryness and inflammation of the internal structures of the eye: retinal vasculitis and uveitis.

Hashimoto's thyroiditis

It is an autoimmune disease (due to antithyroid autoantibodies) that causes inflammation of the thyroid gland. It is a common cause of primary subclinical hypothyroidism due to thyroiditis, with goiter, or frank hypothyroidism. The clinical presentation is the same as any hypothyroid state and therefore, the treatment is thyroid hormone replacement. It is more common in women than in men (in a 14: 1 ratio), usually presenting or detecting between 20 and 30 years of age.

At the ocular level, non-infectious conjunctivitis and sicca syndrome are frequent, due to lacrimal hyposecretion and desiccation of the ocular surface, since these patients usually have altered, less frequent and incomplete blinking.

Seronegative spondyloarthropathies

Spondyloarthropathies are autoimmune inflammatory diseases of the spine, the spine and especially the sacroiliac joints. The term seronegative spondyloarthropathy comes from the fact that the blood or serological examination, called rheumatic factor, is negative. This group includes diseases such as ankylosing spondylitis, psoriatic arthropathy, Reiter's syndrome (or reactive arthritis), Crohn's disease, uveitis, etc. Between 60% and 90% of people suffering from this disease have the HLA-B27 antigen, but only 8% of the population has this antigen.

These patients usually present multiple ocular alterations, especially uveitis, scleritis, conjunctivitis and even corneal involvement. keratitis y ulcers that can reduce vision in a very important way.

Ocular involvement in rheumatic diseases

All these diseases have a great impact at the eye level. They produce inflammatory processes that can affect the most superficial layers of the eye, such as simple conjunctivitis, or the deeper layers, causing episcleritis, scleritis, uveitis and vasculitis in the vessels of the eye. retina. It is important to know this association between rheumatic and ocular diseases, since the correct diagnosis of ocular manifestations can help to reveal the systemic process and vice versa. People who suffer from a rheumatic process with ocular involvement, the latter will not be resolved if the former is not treated correctly. For this reason, it is necessary that the ophthalmologist be first of all a doctor and thus work together with the other specialists. At the ocular surface level, it is worth noting Sjögren's Syndrome, a frequent pathology in immunological diseases.

Sjögren syndrome

It can be primary or secondary, in the primary forms it usually has an idiopathic cause and it aprarece in women between the 4ta. and 5ta. decade of life. In the secondary forms it is associated with autoimmune diseases: rheumatoid arthritis, lupus erythematosus, scleroderma, Hashimoto thyroiditis, etc. The ages of presentation are very variable, more frequent in women.

The eye condition is characterized by the development of dryness and atrophy of the conjunctiva and cornea, calling this condition: Keratoconjunctivitis dry. Which causes a feeling of grit, burning, itching, congestion, decreased tearing that leads to the accumulation of thick bands in the inner corner of the eye, photosensitivity y blurred vision. Secondary infections, ulceration, and iridocyclitis.

cicatricial pemphigoid

It is an idiopathic, chronic and progressive process, more frequent in the elderly and women. It is characterized by the presence of amprecurrent subepithelial pots and vesicles on the skin and mucous membranes, with a tendency to scar formation.

In the eyes it can debut with a papillary conjunctivitis and later form ampsubconjunctival pots that when bursting leave ulcers and pseudomembranes. The most important ocular complications are: severe dry eye, conjunctival adhesions, palpebral adhesions, ectropion cicatricial (eversion of the eyelid outwards).

Steven-Johnson syndrome

Mucocutaneous disease with formation of amppots and vesicles, acute and severe course, usually self-limited. It is more frequent in healthy young people and men.

The causes that can trigger the disease are hypersensitivity reaction to drugs, infections caused by Mycoplasma Pneumoniae and herpes simplex virus.

At the ocular level, it can present with papillary conjunctivitis that can heal without sequelae or produce complications such as: keratinization and conjunctival fibrosis, tabs metaplastic, lacrimal drainage obstruction, ectropion (eyelid eversion outwards) and entropion cicatricial (inward palpebral eversion).

Graft versus host disease

In GVHD, the immune response originates from the donor tissue (generally bone marrow) and is produced against the recipient, who is generally immunocompromised.

Ocular involvement usually manifests as keratoconjunctivitis sicca, due to involvement of the main lacrimal gland, which is infiltrated by donor lymphocytes, causing their destruction.

A corneal complication described in patients with chronic GVHD with Dry Eye Serious is calcareous corneal degeneration (Fig. 4), which consists of the deposition of calcium salts in all the layers of the cornea, sometimes forming large plaques.

As we have seen in this brief review, ocular involvement in rheumatic and autoimmune diseases is very common and in many cases is serious, which is why we insist on the need for the different specialists to collaborate and make the patients who suffer from them aware that before any eye discomfort, consult your ophthalmologist. Early detection is the key to effective treatment.