|Year : 1985 | Volume
| Issue : 1 | Page : 71-72
Ocular involvement in a case of scleroderma
Deptt. of Ophthalmology, Gandhi Medical College, Bhopal, India
Deptt. of Ophthalmology, Gandhi Medical College, Bhopal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Anand R. Ocular involvement in a case of scleroderma. Indian J Ophthalmol 1985;33:71-2
Scleroderma is a rather uncommon disease of unknown origin and is considered to be a collagen disease in which there is hardening or sclerosis of the skin due to hypertrophy, and subsequent atrophy of the connective tissue of the dermis with fibrous tissue replacing the subcutaneous fat. There is a fibrinoid degeneration and perivasculitis of the blood vessels. In addition to the skin involvement there is an extensive involvement of most of the organ systems. A localized form of scleroderma which is benign and unassociated with visceral disease may also occur. Scleroderma usually appears in patients between 35-55 years and women are affected 2-3 times more frequently than men.
| Case report|| |
Mrs. P.B., 27 female, was admitted with complaints of tightness of skin over face, hands and legs for last six months. She also complained of inability to open her mouth fully for the same period [Figure - 1]. The skin over eyelids was taut and shining and could be pinched with difficulty. Folds were obliterated Visual Acuity - Without glasses - Rt Eye 6/18 Lt Eye-6/12.
Anterior segment did not show any abnormality. Other features-skin of the face was shining and gave a rosy waxy appearance Fundus showed small rounded bodies like drusen which surrounded and partly covered the optic disc. There were peripapillary folds Foveal reflex was dull. There were no signs of hypertension and no haemorrhages were seen.
| Discussion|| |
In the primary ocular manifestations of scleroderma the eyelids are involved in 80% of the cases. There is a decreased tear production in 50%, kerato conjunctivitis sicca in 30%, and shallow fornices in 20% of the cases.
Visual impairment is seldom a problem Peyman, et al quote that retinopathy in scleroderma is rare, but occasionally cotton wool spots, disc oedema, retinal oedema, exudates and haemoerrhages have been described. These changes may be seen in the presence or absence of hypertension. Choroidal vascular involvement may lead to nonrhegmatogenous detachments.
In the case described here there were eyelid changes, along with fundus changes showing colloid bodies partly covering the disc. These fundus changes were not accompanied by signs of hypertension.
Precautions to be taken in the cases of scleroderma are repeated check up for any signs of iritis which if present is to be treated.
The tear secretion should also be checked regularly and if necessary treated with lubricating solutions. If lid closure is insufficient because of 'Scleroderma mask' 1% methylcellulose drops at frequent intervals is used to prevent exposure keratitis. Involvement of an extraocular muscle due to myositis suggests generalized inflammatory process and is to be treated with anti inflammatory drugs.
No specific agent has been found to halt the progression of scleroderma and the therapy is directed to manage the manifestations of the disease. Recently Penicillamine has been used experimentally and long term effects are awaited.
| Summary|| |
A case of scleroderma is being reported with characteristic skin changes and interesting fundus findings.
| Acknowledgement|| |
I am very grateful to Prof Santokh Singh, for his valuable guidance.
| References|| |
Duke Elder, S., 1967, System of Ophthalmology (Vol X) London Henery kimpton
West and Barnett, 1979, Brit. J. Ophthalmol
Peyman, G. 1980, A. Sanders D. R. and Gold berg, M. F., 1980, Principles and Practice of Ophthalmology
Ronald M., M.S., 1980, Current Ocular Therapy Fraun felder and Roy.
[Figure - 1]