|
Do your own research physicians have
less time
Communication with physicians managing
the patient’s systemic disease is crucial.
By Katrina Altersitz
Women are as much as 50 times more likely to suffer from
certain autoimmune diseases than men, and these diseases
often have ocular manifestations that ophthalmologists
should be aware of when examining their female patients,
experts say.
“Autoimmune diseases are the No. 1 example of the higher
risk” women carry for certain diseases due to sex, said
Janine A. Smith, MD, of the National Eye Institute. “There
are a lot of autoimmune diseases, and nearly every single
one affects women more than men.”
There is no definitively known reason for this disparity
between the sexes, she said.
Dr. Smith said Sjögren’s syndrome, with its symptoms of
dry eye and dry mouth, is a prime example of an autoimmune
disease seen more often in women. In addition, she said,
systemic lupus erythematosus, rheumatoid arthritis and
thyroid disease all disproportionately affect women, and all
can have ophthalmic manifestations. continued below.
“The immune system between men and women is different,”
Dr. Smith explained. “Even the way men respond to viruses
and women respond to infections, there are differences.”
One theory, she said, is that because estrogens are
naturally proinflammatory and androgens, specifically
testosterone, are considered anti-inflammatory, women are
more prone to developing autoimmune problems.
OSN spoke with Dr. Smith and other experts regarding the
ocular complications of autoimmune disorders, what can be
done to treat them and how to work with internal medicine
specialists and others in management of patients with these
diseases.
Lupus
Systemic lupus erythematosus, a collagen vascular
disease, affects women nine times as often as men. Typically
young, middle-aged women are affected, said C. Stephen
Foster, MD.
Lupus often causes dry eye, for which treatment is much
like that for Sjögren’s syndrome, but there are other
possible ocular complications as well. Usually, Dr. Foster
said, these complications are inflammatory.
“It might be something as relatively trivial as a rash, a
low grade subtle dermatitis on the lid, or something that is
directly relating to the eyeball itself with episodes of
superficial inflammation,” he said. “This superficial
inflammation may be affecting only the conjunctiva or, more
prominently, it will be episodic inflammation of the tissues
deeper to the conjunctiva like the episclera or sclera.”
Recurring episcleritis is a “trivial” but common ocular
complication of lupus, Dr. Foster said. While it rarely
requires aggressive therapy, episodes are often treated with
corticosteroid drops, which can have long-term consequences,
he explained.
“Eventually there is a price to pay, most particularly
with respect to development to cataract,” he said. “We
believe taking an oral nonsteroidal anti-inflammatory
medication is the most productive and appropriate way to
address that.”
Keratitis is another ocular manifestation of lupus.
Patients can develop peripheral keratitis or multifocal
superficial corneal inflammation, leaving small nebulae in
the superficial cornea stroma.
“Both of them are associated with light sensitivity and
photophobia. Both are important because they both carry with
them a little more prognostic significance than does
episcleritis or conjunctivitis,” Dr. Foster explained. “Both
are fairly disabling because of the photophobia.”
He said, again, corticosteroids are usually used for
treatment, but the long-term solution for keratitis is to
address the underlying lupus with systemic medication.
continue to page -2
Click to view different size nerve fibers.
|
