[2005] [SP0129] RETINAL MANIFESTATIONS OF SYSTEMIC VASCULITIS

M.R. Stanford Medical eye unit, St thomas hospital, london, United Kingdom


The purpose of this talk is to review the changes that occur within the eye as a result of a variety of systemic vasculitides. Whilst the most common ocular manifestations of systemic vasculitis are scleritis or episcleritis, involvement of the retinal vasculature does occur and usually indicates a major relapse in systemic disease or the presence of renal involvement leading to accelerated hypertension. Since the changes may be asymptomatic, their recognition is important. Furthermore, retinal changes induced by secondary infection may occur as a consequence of the treatment for systemic disease and may be sight threatening.
In the vasculitides that affect large to medium arteries (giant cell arteritis, Takayashu''s) the principal ocular symptom is visual loss secondary to anterior ischaemic optic neuropathy (AION). A cilio-retinal or central retinal artery occlusion may also be evident. The presence of cotton wool spots separate from the optic disc, devastating visual loss, slow filling on fluorescein angiography and choroidal infarcts are clinical features that help differentiate an arteritic from a non-arteritic anterior ischaemic optic neuropathy. In polyarteritis nodosa, retinal findings include central retinal artery occlusion, AION, retinal arteriolar involvement and choroidal infarction.
Approximately one third of patients with Wegener''s granulomatosis develop ophthalmic involvement. Whilst scleritis is the most common manifestation, retinal arteriolar occlusion may be seen and viral retinitis may arise as a consequence of immuno-suppressive therapy, particularly if there is depression of the CD4 lymphocyte count. The retinal features of Churg-Strauss vasculitis include anterior ischaemic optic neuropathy, central retinal artery occlusion, retinal and choroidal infarction. In systemic lupus, retinal arteriolar vaso-occlusive disease due to immune complex deposition rather than vasculitis, with associated retinal oedema and cotton wool spots occurs. Choroidal vasculitis has been observed in post-mortem material. Retinal signs are always a sign of major systemic relapse and should prompt emergency evaluation of systemic disease. Retinal signs in scleroderma are rare and usually secondary to hypertension, although it has been noted that the signs are often more florid than might be expected for the level of blood pressure. Evaluation of the retinal vasculature can therefore furnish clues to the state of the patient''s systemic vasculitis

Eye and rheumatic diseases