Ocular Manifestations In Patients Research Articles

Ocular complications in adults with psoriasis: a cross-sectional study in a referral center in Brazil

PurposeThere is limited literature on the ocular manifestations in patients with psoriasis. Therefore, this study aimed to identify the prevalence of and factors associated with ocular manifestations in adults with psoriasis.MethodsThis cross-sectional study included Brazilian adults with psoriasis. The dermatological evaluation included diagnosis, clinical form, Psoriasis Area and Severity Index (PASI) measurement, and location of the lesions. Patients underwent a full ophthalmological examination, including the Schirmer I test, Rose Bengala staining, and tear breakup time tests. The results were analyzed using chi-square and Pearson’s linear correlation tests.ResultsOf the 130 patients assessed, 118 (90.8%) exhibited ocular abnormalities, with meibomian gland dysfunction (MGD) being the most prevalent (59.2%), followed by dry eye disease (DED) (56.2%). A significant correlation was observed between MGD and PASI (p = 0.05), and between MGD and certain treatment modalities. DED was significantly associated with PASI (p < 0.05). Concurrent use of acitretin was identified as an independent predictor of MGD (odds ratio [OR] = 3.5, p < 0.05), whereas PASI was a protective factor against DED (OR = 0.39, p < 0.01).ConclusionGiven the high prevalence of eye disease among individuals with psoriasis, routine ophthalmological assessments are recommended to prevent possible ocular complications.

Clinical study of ocular manifestations in patients with newly diagnosed and relapsed hematolymphoid malignancies at a tertiary care hospital

Objectives: To estimate the proportion of ocular manifestations in new and relapsed cases of various hematolymphoid malignancies and to determine an association between these ocular manifestations and the hematological parameters of the patients. Materials and Methods: The study was conducted in the department of ophthalmology in association with medical oncology. All patients with newly diagnosed or presenting with a relapse of hematolymphoid malignancies underwent a complete ocular evaluation. Results: A total of 63 patients were included in this study. The mean age of the patients was 34.71 ± 19.80 years. Acute myeloid leukemia and B-ALL accounted for 73% of the cases. At the time of examination, 47.61% of patients (n = 30) were newly diagnosed and 52.38% (n = 33) had relapsed. Acute leukemias had more probability of having ocular manifestations than chronic leukemias (P = 0.01). Subconjunctival hemorrhage was found to be the most common anterior segment finding (n = 10, 15.87%; P = 0.05). The most common posterior segment finding seen in both the right and left eyes was dot blot hemorrhages (n = 20). Those patients who had hemoglobin counts &lt;6.5 mg/dl had the most ophthalmic manifestations (n = 20); of which Roth spots were seen the most (n = 6; P = 0.04). And those who had platelet counts &lt;50,000 cells/cumm presented with Roth spots (n = 6, P = 0.05) followed by subretinal hemorrhages (n = 5, P = 0.05) and preretinal hemorrhages (n = 5, P = 0.05). Conclusion: Screening to detect ocular manifestations is of importance in hematolymphoid malignancy, especially in newly detected and relapsed cases. A complete ocular examination is recommended in these patients, as most patients are asymptomatic and ocular manifestation could be an early sign of worsening of the disease. Among the various blood parameters, low hemoglobin and platelet counts are definite indicators of the presence of intraretinal bleeding manifestations.

Eye involvement in patients with rheumatoid arthritis: a cross-sectional study

Background: Rheumatoid arthritis (RA) is a systemic immune disease. The authors aimed to report the characteristics of ocular manifestations in patients with RA. Methods: Demographic and clinical characteristics were collected including: age, sex, and BMI. Disease data included the duration, the present main complaint, including the number of painful and swollen joints, duration of morning stiffness, and the patient’s self-evaluation form had also been applied and registered. Eye symptom including pain, dryness, redness, photophobia, discharge, and blurred vision was asked and registered, in addition to full medical history, treatment, and evaluation of clinical disease activity index. Rheumatologic examination included: the number of tender and swollen joints in patients was done. All study subjects underwent complete ophthalmological examination in the following manner: visual acuity assessment by Snellen’s chart, evaluation of pupil diameter and reflexes as well as eyeball movements, tear film evaluation by using Schirmer’s test, intraocular pressure measurement, slit-lamp evaluation of the anterior segment with concentration on ocular surface assessment, followed by installation of topical mydriatic/cycloplegic eyedrops for posterior eye segment exam and fundoscopy. Laboratory tests included rheumatic factor, anti cytoplasmic citrulinted peptide, C-reactive protein, and erythrocyte sedimentation rate were performed and analyzed. Results: Mean age of study group was 41.5±10 years,78.59% of which were females. Ocular manifestations were present in 31.14%. Dry eye was diagnosed in (36.71%), among which burning sensation was found in (35.15%), and photophopia in (27.34%). The most frequent ocular manifestation was episcleritis (66.40%), while scleritis was diagnosed in (22.65%), and keratoconjuctivitis was present in (7.04%). Discussion: The most common manifestations of ocular involvement in our RA patients was episcleritis, dry eye, and scleritis. Positive serum rheumatoid factor and anticitrulinated peptide antibody significantly increased the risk of having ocular manifestations, especially dry eyes, and the ocular manifestations prevalence was higher among male patients, long disease duration and treatment with biologics and disease-modifying antirheumatic drugs. Conclusion: Ocular symptoms are relatively frequent manifestation of RA. Regular ophthalmological examinations are essential among patients with RA.

Ocular manifestations in patients with autoimmune bullous dermatoses: A hospital-based retrospective study

Background: Ocular involvement in autoimmune bullous dermatoses (AIBD) remains underappreciated. Objectives: The objective was to study the prevalence and characteristics of ocular involvement in patients with AIBD. Methods: The medical records of 25 patients (males: females 11:14) aged between 27 and 85 years (mean ± standard deviation = 44.9 ± 15.6 years) with AIBD were analyzed retrospectively for clinico-epidemiological attributes and the presence of ocular abnormalities. Results: There were 20 (80%) pemphigus patients, of which most were pemphigus vulgaris (PV, n = 14) and pemphigus foliaceus (PF, n = 6). Other 5 (20%) patients included bullous pemphigoid (BP, n = 4) and cicatricial pemphigoid (CP, n = 1). Seventeen (68%) patients comprising 11 (78.6%) of PV, 3 (50%) of PF, 2 (50%) of BP, and 1 (100%) of CP had 27 ocular abnormalities. Erosions of lid margins (n = 3, 27.3%), blepharitis with meibomitis (n = 1, 9.1%), chalazion (n = 1, 9.1%), and conjunctival vesicles over bulbar conjunctivae (n = 2, 18.2%), conjunctivitis (PV = 5, 45.5%, PF = 1, 33.3%), and symblepharon and keratoconjunctivitis sicca in one (9.1%) patient each, respectively, were major ocular manifestations in pemphigus. Entropion with trichiasis, shallow fornices, and corneal opacities were major abnormalities in patients with BP (n = 2, 100%) and CP (n = 1, 100%). Conclusion: Ocular comorbidities vary in prevalence and severity between subtypes of AIBD. These are mainly from complications of ocular surface disease predominantly affecting the anterior segment of the eye. They are more severe in patients with CP compared to others. The study is limited by a single-center, retrospective-study design, a small number of patients in each group for stratification, and long-term follow-up.

Ocular Manifestations Of Hiv Patients At Ophthalmology Polyclinic Of Prof.Dr.I.G.N.G.Ngoerah Hospital January 2019 - December 2021

Abstract&#x0D; Introduction &amp; Objectives : Human Immunodeficiency Virus (HIV) is a disorder that affects many organs including the eyes. It is highly recommended that HIV patients be referred to an ophthalmologist before experiencing symptoms.To determine the ocular manifestations in HIV patients&#x0D; Methods : This was an observational study with anayltic cross-sectional approach. Data was collected retrospectively from medical records of HIV patients who visited Ophthalmology Polyclinic at Prof.Dr.I.G.N.G. Ngoerah Hospital Denpasar for the period 1 January 2019 – 31 December 2021. Data analysis was performed using chi-square test in SPSS version 22&#x0D; Results : There were 52 patients included, mostly were male (61.5%), aged 30-39 years (40.4%), WHO stage IV (63.5%) taking 1st Highly Active Antiretroviral Theraphy (HAART) (75%), have been diagnosed with HIV and consume (HAART) for 1-5 years, CD4 100-249 (42.3%), BCVA &lt;3/60 (46.2%), and had not ckecked their HIV RNA (77.2%). There were 71 occurrences of HIV ocular manifestations with dry eye as the most common type (31%), followed by ocular CMV (26.8%). In patients with CD4 &lt; 250, the most ocular manifestations were dry eye, in CD4 250-500 were dry eye and ocular syphilis, whereas in CD4 &gt; 500 were ocular toxoplasmosis and ocular syphilis. There is no relationship between the use of HAART and dry eye syndrome&#x0D; Conclusion : The most common ocular manifestations of HIV patients at the Ophthalmology Polyclinic of Prof.Dr.I.G.N.G.Ngoerah Hospital was dry eyes. Ocular manifestations in patients with CD4 &lt;500 was dry eye whereas those with CD4&gt;500 was ocular toxoplasmosis and syphilis.

OCULAR MANIFESTATIONS OF CONNECTIVE TISSUE DISORDERS: A DESCRIPTIVE CROSS SECTIONAL STUDY

Background and Objectives: Connective tissue disorders (CTD) includes a group of chronic inflammatory conditions that affects multiple systems of the body and presents wide spectrum of clinical manifestations including eye. This study was undertaken to study the types of ophthalmic manifestation in connective tissue disorders. Method: A descriptive cross-sectional study of 50 cases was done in patients diagnosed with various connective tissue disorder in tertiary care hospital, from June 2022 to May 2023.All patients underwent a standard and comprehensive ophthalmic evaluation. Result: Out of 50 cases, 12 were males and 38 were females. Maximum number of cases (35) were seen between the age group of 40-61years. Rheumatoid Arthritis (25) was the most common connective tissue disorder. Both anterior and posterior segment findings were seen in our study with Dry eye as the most common ocular manifestation which was seen in 28 patients. Conclusion: Connective tissue disorderscomprise wide spectrum of diseases that can present with ocular involvement. It is important to do screening of ocular manifestations in patients with connective tissue disorder for early detection and treatment for better prognosis.

Ocular Manifestations of Human Immunodeficiency Virus Infection in the Combination Antiretroviral Therapy Era.

Since the introduction of combination antiretroviral therapy (cART) in Japan in 2008, the spectrum of ocular manifestations in patients with human immunodeficiency virus (HIV) has changed. This study, conducted at Tokyo Medical and Dental University Hospital between January 2012 and August 2023, aimed to understand the epidemiology and clinical features of ocular manifestations in patients with HIV during the cART era. Of the 218 patients diagnosed with HIV, 23 (10.55%) exhibited ocular manifestations; all were male, aged 32-73. The most prevalent ocular complication was uveitis (60.67%). Notably, the prevalence of uveitis in this cART era has surged compared to earlier Japanese studies. Our data also suggest a potential direct link between uveitis and HIV, particularly in patients who have not yet undergone cART. However, cytomegalovirus retinitis, another prevalent ocular disease in our study, appeared more strongly associated with patients who commenced cART. Neither ocular condition was significantly correlated with CD4+ T-cell count. Importantly, our observed ocular manifestation prevalence (10.55%) was lower than that in previous studies, emphasizing the potential influence of cART and national healthcare support. These findings provide unique insights into the evolution of ocular manifestations in patients with HIV in Japan amidst cART availability.

Ocular Manifestations in Patients Affected by p63-Associated Disorders: Ectrodactyly-Ectodermal Dysplasia-Clefting (EEC) and Ankyloblepharon-Ectodermal Defects-Cleft Lip Palate (AEC) Syndromes

Background/Aims: The Ectrodactyly-Ectodermal dysplasia-Clefting (EEC) and Ankyloblepharon–ectodermal defect–cleft lip/palate (AEC) syndromes are rare autosomal dominant diseases caused by heterozygous mutations in the p63 gene. Patients are characterized by abnormalities of the skin, teeth, and hair and have limb defects, orofacial clefting and ectodermal dysplasia. In addition, they often show ocular surface alterations, leading to progressive corneal clouding and eventually blindness. Here, we present 8 cases describing patients affected by EEC (n = 6, with 5 sporadic and 1 familial cases) and AEC (n = 2, both sporadic cases) syndromes. We attempt to provide a description of the ocular disease progression over the years. Methods: Clinical examinations and monitoring of ocular parameters for the assessment of limbal stem cell deficiency were constantly performed on patients between 2009 and 2023. Quantitative data and comparison with existing cases described in the literature are reported. Results: The therapies supplied to patients were essential for the management of the symptoms, but unfortunately did not halt the progression of the pathology. Conclusions: A constant monitoring of the patients would help avoid the sudden worsening of symptoms. If the progression of the disease slows down, it would allow for the development of newer therapeutic strategies aimed at correcting the genetic defect.

Assessment of alterations in the retina and vitreous in pre- and post-COVID-19 patients using swept-source optical coherence tomography and angiography: A comparative study.

Ocular manifestations have been well recognized in coronavirus disease 2019 (COVID-19) outbreak. Several studies have detected ocular manifestations in patients after COVID-19. However, little is known about the retinal and vitreal alterations in patients before and after COVID-19 infection. This study aimed to investigate the retinal and vitreal alterations in patients before and after contracting COVID-19 infection using swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA). A total of 38 participants (76 eyes) were enrolled and followed-up 1 month after COVID-19 infection. Then, 26 patients (52 eyes) were evaluated 3 months after COVID-19 infection. Compared with the pre-COVID-19 status, patients with 1- and 3-month post-COVID-19 statuses had significant thinning of ganglion cell and inner plexiform layer, thickening of inner nuclear layer, a decrease in the vessel density (VD) of superficial vascular complex, and an increase in the VD of deep vascular complex. Meanwhile, alteration in parameters of foveal avascular zone (all p < 0.05) and hyper-reflective dots in the vitreous of 27 patients (54 eyes) (71.1% vs. pre-COVID-19, 34.2%, p = 0.006) were observed. These findings suggest significantly retinal and vitreal alterations occurred in patients after COVID-19 infection, possibly due to direct or indirect virus-induced injuries. Further longitudinal studies are required to investigate the long-term effects of COVID-19 infection on the human eyes.

A Case-Control Seroprevalence Survey of Toxoplasmosis in Hemodialysis Patients and Healthy Subjects in Kazeroon and Jahrom Districts in Fars Province, Southern Iran.

Opportunistic parasites such as Toxoplasma gondii (T. gondii) are capable of causing neurological and ocular manifestations in patients undergoing hemodialysis. By designing a matched case-control study, we conducted a seromolecular survey of T. gondii in hemodialysis patients compared to a healthy group from Jahrom and Kazeroon cities in Fars Province, Iran. For this purpose, 75 hemodialysis patients from Kazeroon city, 75 hemodialysis patients from Jahrom city, and 75 healthy individuals were recruited for the study. The serum levels of specific immunoglobulins (IgG/IgM) in the case and control groups were evaluated using the enzyme-linked immunosorbent assay (ELISA) method. Also, buffy coat samples were used to extract genomic DNA. Then, Polymerase Chain Reaction (PCR) was accomplished using the RE and GRA6 genes of T. gondii. A standard questionnaire containing demographic factors was administered. Although the seroprevalence of the anti-T. gondii IgG antibody in hemodialysis patients from Kazeroon (18.66% (14/75)) and Jahrom (25.33% (19/75)) was higher than that in the control group (13.33% (10/75)), no statistically significant difference was observed between the case and control groups (P value = 0.373 from Kazeroon and P value = 0.354 from Jahrom). Among the studied variables, only residence (urban) was significantly associated with the anti-T. gondii IgG antibody in the case group from Kazeroon. Also, no IgM antibody titers and DNA of T. gondii were detected in the case and control groups from both cities. Although high seroprevalence of anti-T. gondii IgG antibody was seen in hemodialysis patients, further epidemiological studies with larger samples need to be done in Jahrom and Kazeroon cities and in other parts of Iran. It is also necessary for health officials to establish programs for the prevention and control of T. gondii infection in hemodialysis patients.

A CLINICAL STUDY ON KERATOMYCOSIS IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL

AIM : To study etiology , epidemiological factors leading to keratomycosis in various subgroups of population like different age and sex groups. To determine spectrum of ocular manifestations in patients with keratomycosis. METHODS : This is a prospective study done in 100 patients of fungal keratitis over a period of 1 year with proper recordings of snellens visual acuity chart, slit lamp biomicroscopy, direct and indirect ophthalmoscopy, conrmed by culture, histology and confocal microscopy, PCR, in patients attending tertiary care hospital , kakinada. This study was conducted in 100 pati RESULTS : ents , of most common age group was 31-40 years i.e, which most exposed to trauma to cornea with vegetative matter, immunocompromised people, over usage of steroids and antibiotics and many factors. Males are more affected and among agricultural workers with mostly unilateral in presentation. Majority presented with pain, redness , foreign body sensations, defective vision. Ulcer is dirty looking, feathery margins with wessely ring and satellite lesions. CONCLUSION: Fungal infections of cornea continue to be an important cause of ocular morbidity, particularly in the communities of agriculture of developing countries. A proper understanding of agent and host factors involved in these infections will improve the outcome of this condition.

A CLINICAL STUDY OF BACTERIAL KERATITIS IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL

Aim: To study about the etiological and epidemiological factors,and also the spectrum of ocular manifestations in patients with viral keratitis. It is a prospective study done over a period of 3 Methods: months from June to August 2022.A group of 100 patients of bacterial keratitis from East Godavari district attending Ophthalmology OPD, Government General Hospital, Kakinada , with complaints of visual disturbances in all age groups .All of these patients underwent thorough anterior and posterior segment examination and all other necessary investigations like gram and giemsa staining,AFB staining and bacterial culture. O Results: ut of 100 patients studied,staphylococcus is the most common causative organism of bacterial keratitis.It is usually unilateral,with more incidence in males and in elderly age group.Contact lens wear is the main predisposing factor as per the study.Most of the patients presents with pain and redness and in case of severe bacterial keratitis,if untreated or in case of treatment failure ,it can end up in complications like corneal scarring ,recurrence,toxic iridocyclitis and eventually in phthisis bulbi and even endophthalmitis. Bacteria Conclusion: l keratitis is a potentially sight threatening corneal infection in human eyes.It can proceed very rapidly with complete corneal destruction in few days.Early diagnosis and prompt treatment will help us to minimise the damage and ocular morbidity and thus helps in providing a better visual outcome.

A CLINICAL STUDY OF OCULAR CAUSES OF HEADACHE

Aims :To enumerate the Ocular causes of headache. Objectives: 1. To assess the various Ocular manifestations in patients with headache. 2. To study the various causes of headache and early diagnosis of various causes of headache 3. To assess the severity of Ocular manifestations in patient who present with headache Materials and Methods: This was a Hospital based cross sectional study done on patients who attended to OPD with a cheif complaint of headache, Dr. R.S.P.R Government Regional Eye Hospital, Andhra Medical College, Visakhapatnam from August 2021 to August 2022. Relevant detailed history and Ocular examination was done. Results: Outof 100,35(53.9%)has Refractive errors,10(12.8%)has Convergence insufficiency,14(17.95%)hasAccomadativeinsufficiency,7(9%)hasHeterophorias,1(1.3%)has Heterotropias,5(5%)has Systemic diseases. Majority were in the age group between 21-30yrs(31%)in which 13% males,17%females and least are under 0-10 and 61-70 years(3%). 52(52%)had Eye strain,10(10%)had Photophobia,12(12%)had Raised IOP, 10(10%)had Nausea,5(5%)had Frequent blinking, 5(5% )had Vertigo,3(3%)had diseases of External eye and adnexia2(2%) had Scalp tenderness 1(1%) had Photopsia and 1(1%)Iatrogenic. Conclusion: Early detection and management of Refractive errors and Accomodative squint and distinguishing the other causes of headache like migraine, sinusitis, and systemic diseases like hypertension and benign tumours.

Ocular Manifestations in Patients with Sensorineural Hearing Loss.

Identification of ocular manifestations in patients with sensorineural hearing loss (SNHL) can have a large impact on the outcome and treatment of pediatric patients. Due to the common co-incidence of ocular manifestations and SNHL in children, both ophthalmologic and hearing loss screening and routine examinations must be conducted to minimize adverse outcomes and worsening of pathology. Early evaluation and diagnosis is imperative for intervention and further development of the patient. Co-incidence requires a thorough evaluation that includes a comprehensive history, examination, and diagnostic testing. In this article, a literature review was conducted to analyze the presentations of various diseases and syndromes, such as Alport Syndrome, Waardenburg Syndrome, Norrie Disease, Usher Disease, Stickler Syndrome, Marfan Syndrome, Congenital Rubella, and Hereditary Optic Neuropathies. We divided the various ocular pathologies into anterior and posterior segment presentations and associated systemic findings for better understanding. Additionally, this review aims to include an update on the management of patients with both ocular and hearing loss manifestations.

ODP306 Diplopia as Presenting Manifestation of Acromegaly

Abstract Introduction Acromegaly is a chronic disorder characterized by excess growth hormone production, withclinical manifestations ranging from subtle signs to significant systemic complications. We describe a patient who presented with diplopia as initial symptom of acromegaly. Clinical case: A 72-year-old female patient was referred for diplopia. Upon questioning, she reported headache, muscle aches and heavy sweating. On physical assessment, she had coarse facial features, thickened tongue and hand enlargement. Orbital CT images revealed a mild to moderate symmetric enlargement of the extraocular muscle which spared myotendinous junction. MRI sella showed a 12 mm pituitary adenoma. The diagnosis of acromegaly was confirmed with high IGF-1 and oral glucose tolerance test. The patient underwent endoscopic debulking of the pituitary tumor and pathology showed a densely granulated GH producing adenoma. Upon follow up, she reported improvement of the diplopia which was completely corrected with prism glasses. Remission of acromegaly was confirmed biochemically and repeated MRI sella showed no residual tumor. Conclusion Acromegaly is the most likely cause of extraocular muscle enlargement with subsequent diplopia in this patient. Ocular manifestations in patients with acromegaly include visual field defect, excessive lacrimation, proptosis and double vision. This case adds to previous literature that diplopia could be the presenting manifestation of acromegaly. This is the first case reporting of improvement of diplopia following remission of acromegaly. Comprehensive ophthalmic assessment of patients presenting with eye symptoms and features suggestive of acromegaly is of value as it helps with early diagnosis as well as improving the outcome of this condition. Presentation: No date and time listed

OCULAR MANIFESTATIONS IN GENODERMATOSES.

PURPOSE: To evaluate the Ocular manifestations in patients with genodermatoses. METHODS: 49 cases in age group 16-60 years, with a diagnosis of genodermatoses were included in the study. All the patients underwent a complete ophthalmic examination, the ndings were noted. RESULTS: The most common condition noted was NF 1(23 cases) and NF 2 (18 cases). Other diseases seen were Dariers disease (1 case) Lamellar ichthyosis (7 cases) and Epidermal nevus syndrome (1 case). 10 cases out of 23(43.47%) having NF1 showed Lisch nodules, 13(56.52%) showed eyelid neurobromas and 1(4%) showed optic nerve glioma. In patients with NF2, 2 cases (11.11%) showed cataracts. Among patients with lamellar ichthyosis, 1 case (14.28%) had ectropion. In the patient with Epidermal nevus syndrome retinal pigment epithelium changes were seen. No ocular nding was seen in the patient with Dariers disease. Genodermatoses have si CONCLUSION: gnicant ocular ndings. These conditions are rare and hence it is essential to have a complete assessment of these patients with respect to ophthalmological manifestations for better diagnosis and earlier management.

S2757 Eye-BD—A Rare Case of Orbital Myositis as an Extra-intestinal Manifestation of Crohn’s Disease

Introduction: Crohn’s Disease (CD) is often associated with a diverse array of extra-intestinal manifestations (EIMs). The estimated prevalence of EIMs in patients with CD is 25-70%. The estimated prevalence of ocular manifestations in patients with CD is 3.5-6.8%. Orbital myositis (OM), characterized by inflammation of the extraocular muscles, is a rare ocular EIM associated with CD. Case Description/Methods: A 22-year-old female with CD on ustekinumab for maintenance therapy in remission presented with three days of right eye swelling and pain with extraocular movements. CT of the orbits reported minimal pre-septal tissue swelling, without evidence of orbital cellulitis. She was started on NSAIDs. A week later, the patient presented to the Ophthalmology clinic with resolution of her right eye symptoms but with new, similar symptoms in her left eye, including diplopia, restriction of lateral and medial gaze, and chemosis of the lateral conjunctiva. She denied symptoms concerning for a Crohn’s flare or other EIMs. The initial CT of the orbits was reviewed, and an addendum was made, reporting subtle enlargements of multiple extra-ocular muscles in the right orbit. She was diagnosed with bilateral OM. Infectious, endocrine, and autoimmune work-up was performed which were unrevealing and her OM was likely an EIM of her CD. She was started on prednisone 40 mg daily, which resulted in complete resolution of her symptoms at one-week follow-up. She was kept on ustekinumab maintenance therapy as she remained in clinical remission without evidence of other EIMs and completed her steroid taper without further complication. The patient was informed of the high recurrence rate of CD-associated OM and close follow-up was arranged. (Figure) Discussion: Overall, our patient’s OM was a likely EIM of her CD, as further laboratory work-up for commonly implicated etiologies to include thyroid disease, vasculitides, sarcoidosis, and IgG4-related disease was all negative. This case illustrates a rare EIM of CD in a patient believed to be in clinical remission, emphasizing the point that certain EIMs may occur independently of gastrointestinal luminal disease activity. Given that a high index of suspicion was necessary to reach the diagnosis given the subtle exam and imaging findings, this case also reiterates the importance of timely diagnosis and early management to minimize morbidity risk, which can be best accomplished through multidisciplinary coordination among subspecialty providers.Figure 1.: Orbital CT, Coronal- Asymmetric enlargement of the medial rectus in the RT orbit.

Ocular Manifestations in Patients with Inflammatory Bowel Disease in the Biologics Era.

Background: Extra-intestinal manifestations are frequent in inflammatory bowel disease (IBD). Ocular disorders are generally under diagnosed as they are challenging diagnosis. Aims: We assessed the prevalence of ophthalmological manifestations in patients with IBD, and investigated characteristics associated with ocular manifestations. Methods: We performed a retrospective study including patients followed for IBD and had an ophthalmologic visit from January 2013 to July 2020, among 1432 patients followed during this period. Two groups were considered: the first group included patients whose an ocular diagnosis was considered as “related to IBD”, and the second group including patients whose an ocular diagnosis was considered “not related to IBD”. Results: Among 1432 patients with IBD, eighty-seven (6.1%) patients had an ophthalmologic visit. Fifty-three patients (3.7%) were considered to have an ocular extra-intestinal manifestation or an iatrogenic effect of IBD treatment, and 34 diagnoses (2.4%) were considered not related to IBD. Inflammatory surface pathologies were the most frequent (33.2%), including 15 patients with dry eye (17.2%), 9 with blepharitis (10.3%), and 5 with chalazions (meibomian cyst) (5.7%). Uveitis was diagnosed in 13 patients (14.9%), episcleritis in 5 patients (5.7%), and scleritis in 2 patients (2.3%). Characteristics of patients with an ophthalmological diagnosis “related to IBD” versus “not related to IBD” were not statistically different. Conclusion: In our cohort, less than 5% of patients had ophthalmological extra-intestinal manifestation. The most frequent ocular diagnosis were dry eye and uveitis. No disease characteristics of IBD were found to be associated with ocular manifestations.

Characteristics and Clinical Ocular Manifestations in Patients with Acute Corneal Graft Rejection after Receiving the COVID-19 Vaccine: A Systematic Review.

This study aimed to determine the characteristics and clinical ocular manifestations of acute corneal graft rejection after coronavirus disease 2019 (COVID-19) vaccination. We conducted an online search of the PubMed and EMBASE databases. Data on recipients’ characteristics, corneal transplantation types, interval between vaccination and allograft rejection, clinical manifestations, and graft rejection medication were extracted. Thirteen articles on 21 patients (23 eyes) with acute corneal graft rejection after COVID-19 vaccination, published between April and December 2021, were included. The median (interquartile range) age at the onset of rejection was 68 (27–83) years. Types of transplantation included penetrating keratoplasty (12 eyes), Descemet membrane endothelial keratoplasty (six eyes), Descemet stripping automated endothelial keratoplasty (four eyes), and living-related conjunctival-limbal allograft (one eye). The interval between vaccination and rejection ranged from 1 day to 6 weeks. Corneal edema was the leading clinical manifestation (20 eyes), followed by keratic precipitates (14 eyes) and conjunctival or ciliary injection (14 eyes). Medications included frequently applied topical corticosteroids (12 eyes), followed by a combination of topical and oral corticosteroids (four eyes). In addition, the clinical characteristics of corneal allograft rejection after COVID-19 vaccination were identified. Corneal transplant recipients may require further vaccination, necessitating appropriate management and treatment.

Ocular Manifestations Related to Antibodies Positivity and Inflammatory Biomarkers in a Rheumatological Cohort.

PurposeOcular involvement is frequent in autoimmune diseases and even can be the first manifestation. There are multiple descriptions in the literature around the world regarding this topic. However, we evidenced a lack of studies analyzing the relationship between the ocular manifestations and systemic biomarkers, especially in Latinamerica. Therefore, this study aimed to examine the relationship between the positivity of inflammatory biomarkers and the ocular manifestations in a Colombian cohort of rheumatological patients.Patients and MethodsWe conducted an observational, descriptive, non-comparative cross-sectional study in a rheumatology center, in Bogotá, Colombia, from 2013 to 2019. We calculated a sample size of 797 patients to assess the prevalence of ocular manifestations and inflammatory biomarkers. We performed univariate analyses for categorical and continuous variables and bivariate analyses using the Chi-square and Fisher’s exact test for categorical variables.ResultsWomen represented 84% of the population, and the mean age was 54.61± 15.64 years. Of 797 patients, 21.45% reported one or more ophthalmological diagnoses, being keratoconjunctivitis sicca (KCS) the most common (15.93%), followed by uveitis, and cataract (1.38%, each one). Regarding ophthalmological symptoms, 35% presented at least one, being dry eye sensation (DE) the most common (30.86%), followed by ocular pain (2.76%), red eye, and decreased visual acuity (2.63%, each one). The antibodies or inflammatory biomarkers most frequently found were antinuclear antibodies (ANAs) (35.3%), C-reactive protein (28.7%), and rheumatoid factor (27.9%). We found statistical associations between consumption of complement 3, anti-CCP, anti-RO, and anti-LA antibodies with ocular manifestations such as photophobia, DE, conjunctivitis, KCS, uveitis, retinal vasculitis, and maculopathy.ConclusionOcular manifestations are frequently found in patients with positive antibodies and inflammatory biomarkers. Our results suggest antibodies and inflammatory molecules could be biomarkers for ocular manifestations in patients with rheumatological diseases. This study provides the basis for future longitudinal studies.