“…4,11,14,18,19,[25][26][27][28] Of the 21 cases in which the systemic diagnosis was made first (when the information was provided), there was an average lag period of 62.7 months before the eye involvement was noted. 4,11,12,14,16,17,[19][20][21][22][23]25,27 In the six cases in which eye involvement was the first sign noted, there was an average period of 18 months before systemic signs were noted. 4,12,13,15,26,28 In four cases, the ocular and systemic involvement were noted simultaneously.…”