Thirty-four patients with connective tissue diseases used dexamethasone drops 01% in one eye for 6 weeks. There was a higher incidence of positive steroid response than would be expected in a normal population. Most of the male patients were responders. Care should be exercised when prescribing local steroids for these patients. Males should be offered regular screening for glaucoma. Eye involvement is a prominent feature of connective tissue diseases (CTD). Keratoconjunctivitis sicca (KCS) is the commonest complication, occurring in 11% of patients with rheumatoid arthritis (RA)I and sporadically in systemic lupus erythematous (SLE), progressive systemic sclerosis (PSS), polymyositis, and psoriatic arthritis. Scleritis appears in 067% of RA patients and in other cases of CID (e.g., ankylosing spondylitis and Behget's disease) from time to time. Uveitis is of particular importance in juvenile rheumatoid arthritis, ankylosing spondylitis, and Reiter's syndrome. Conjunctivitis is one of the diagnostic criteria for Reiter's syndrome. Proptosis, diplopia due to extraocular myopathy, corneal disturbances, optic neuritis, and retinal vascular changes may occur is SLE and lid shortening and iris atrophy in PSS. Discolouration and oedema of the lids and extraocular muscle changes occur in polymyositis and dermatomyositis and retinal vasculitis in up to 20% of patients with polyarteritis nodosa. The large host of ocular phenomena that are reported make it unlikely that the trabecular meshwork is exempt from autoimmune inflammatory processes, though glaucoma is not a recognised complication of CTD. The intertrabecular spaces of the 'pore' area of the trabecular meshwork are lined by a layer of mucopolysaccharide.2 If this layer is removed by hyaluronidase, resistance to aqueous outflow falls. Topical steroids increase outflow resistance. This may be due to increased production of mucopolysaccharide

SummaryA patient exhibiting typical features of classical rheumatoid arthritis and psoriatic spondylitis is described. The patient, a woman, presented at the age of 29 with an inflammatory arthritis. Twenty years later, she developed psoriasis, and after a further 3 years, she was first noted to have rheumatoid nodules and to be strongly seropositive. Now at the age of 60, she has a rigid spine with radiographic changes of spondylitis. Neither rheumatoid arthritis, nor psoriatic spondylitis can account for all the features of her disease and there is evidence to suggest that both conditions combined to damage her peripheral joints.