Ankylosing Spondylitis: Ophthalmologist Plays a Major Crucial Role!

Abstract

BACKGROUNDAnkylosing spondylitis (AS) is a chronic inflammatory systemic disorder affecting the axial skeleton with chronic pain and stiffness in the lower back or buttocks region and progressive limitation of spinal movements. Many patients exhibit extra-articular manifestations and anterior uveitis is a common form of extra articular manifestation of AS. Other findings are episcleritis, scleritis, peripheral ulcerative keratitis, retinal vasculitis, dry eye, cataract and secondary glaucoma. Sometimes ocular signs are the only presentation. It is very challenging for an ophthalmologist to carefully examine the patients of AS so that permanent bony deformity is minimised. We wanted to evaluate the magnitude of ocular manifestations in patients suffering from AS and establish the statistical significance of age of patients and determine the frequency of ocular manifestations for epidemiological purposes. METHODSThis is a cross sectional observational study done among one hundred and forty-four patients (n=144) with AS conducted between December 2018 and July 2019. Slit lamp biomicroscopy with 90 D Volk lens was done for anterior and posterior segment examination. Gonioscopy, Applanation Tonometry, Automated Perimetry and Indirect Ophthalmoscopy were done. Schirmer's and TBUT tests were done. RESULTSAnterior uveitis (30%) was the most common ocular manifestation followed by vitritis (18%), cataract (15.2%), episcleritis and scleritis (7.6%), dry eye (6.2%), retinal vasculitis (8%) and peripheral ulcerative keratitis (5%). Males are more commonly affected. The duration of disease was found to be statistically significant (p<0.001) when correlated with age groups with patients in the age group of >60 years and with respect to unilateral/bilateral presentation of ocular manifestations (p=0.016). CONCLUSIONSOphthalmologist has a great role for diagnosing of AS. Patients usually come to ophthalmology OPD for management of ocular symptoms with undiagnosed AS and physician must be cautious while assessing ocular signs and symptoms for suspecting AS. As a result, irreversible bony deformities can be minimized as much as possible.HOW TO CITE THIS ARTICLE: Babu SS, Maiti P, Islam MN. Ankylosing spondylitis: ophthalmologist plays a major crucial role!.