Steroid responsiveness in connective tissue diseases.

Abstract

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

Steroid-Induced Iatrogenic Glaucoma

“…In a study of 34 patients with connective tissue disease, mainly rheumatoid arthritis, who used 0.1% dexamethasone drops in one eye for 6 weeks, Gaston et al [45] reported a higher incidence of positive steroid response than would be expected in a normal population. Additionally, most of the male patients were responders.…”

“…The possibility of high response is greater in the following cases: patients with primary open-angle glaucoma (POAG) or glaucoma suspects, first-degree relatives with POAG [44] , old age or age less than 6 years, connective tissue disease, especially rheumatoid arthritis in men [45] , high myopia [46,47] , type 1 diabetes mellitus [37,48] , and angle recession glaucoma [49] . Patients with predisposing risk factors should be monitored more diligently when receiving corticosteroids.…”

Corticosteroid-induced glaucoma: a review of the literature

“…It has been reported that there is a greater risk of corticosteroid response in patients with certain types of connective tissue disease, 9 type I diabetes, 10 a first-degree relative with primary open-angle glaucoma (POAG), [11][12][13] or high myopia. 14,15 Other steroid-induced ocular effects that have been reported include an increase in corneal thickness and a slight mydriasis, but these changes have not been shown to correlate with an ocular hypertensive response.…”

Effect of Intravitreal Injection of Dexamethasone 0.7 mg (Ozurdex®) on Intraocular Pressure in Patients with Macular Edema

“…IOP levels exceeded 31 mm Hg [2,3] . An elevation in IOP in response to corticosteroid therapy is more frequently observed in patients with primary open-angle glaucoma (POAG) [4,5] and a positive family history for POAG [6] , in children (especially under the age of 6 years) [7] , and in patients with type 1 diabetes mellitus [8] , high myopia [9] , connective tissue disease (especially rheumatoid arthritis) [10] and angle recession [11] . A moderate increase in IOP can be observed in 18-36% of the general population in response to topical corticosteroid treatment, whereas only 5-6% of the general population versus 46-92% of patients with POAG will have a significant and potentially harmful increase in IOP [4,5,[12][13][14] .…”