Scleroderma is a systemic autoimmune condition characterized by the overproduction of collagen, a component of connective tissue, which leads to its hardening and tightening. While known for its effects on the skin, scleroderma’s systemic nature means it can influence various internal organs. The disease process can extend to the delicate tissues of the eyes, leading to a range of potential issues that require management.
Eyelid and Ocular Surface Changes
The most frequent eye-related changes in scleroderma involve the eyelids and the surface of the eye. Fibrosis, the thickening and hardening of skin tissue, can affect the eyelids and reduce their elasticity. This change can make it difficult to close the eyes completely, a condition known as lagophthalmos. When the eyelids cannot form a complete seal, the ocular surface is left exposed, leading to chronic irritation and an increased risk of corneal injury.
This exposure is often compounded by dry eye syndrome, medically termed keratoconjunctivitis sicca. Dryness can arise from fibrosis of the lacrimal gland, which produces the watery component of tears. It can also be a feature of secondary Sjögren’s syndrome, another autoimmune condition that frequently co-occurs with scleroderma. Resulting symptoms include:
- A persistent gritty or sandy sensation
- Burning
- Redness
- Light sensitivity
- Intermittently blurry vision
Internal Eye and Vascular Complications
Beyond the surface, scleroderma can impact the internal structures of the eye through its effects on small blood vessels, a condition known as vasculopathy. This can manifest as scleroderma retinopathy, where the retina’s delicate blood vessels are affected. This may involve blockages or leakage from these vessels, sometimes leading to retinal bleeding or the formation of hard exudates (deposits of fats in the retinal tissue). These changes can disrupt normal retinal function and affect vision.
The disease can also contribute to an increased risk for glaucoma. This connection is thought to be related to chronic circulatory problems affecting the optic nerve, which can become damaged from insufficient blood flow or increased pressure inside the eye. While glaucoma often develops without early symptoms, it can gradually lead to vision loss if not managed. Additionally, cataracts, a clouding of the lens, can sometimes be associated with the long-term use of corticosteroid medications used to manage scleroderma, rather than being a direct result of the disease.
Diagnostic and Monitoring Procedures
Regular and thorough eye examinations with an ophthalmologist are recommended for anyone diagnosed with scleroderma, even without noticeable symptoms. A primary diagnostic tool is the slit-lamp examination, which uses a high-magnification microscope for a detailed view of the eye’s structures. This allows for the early detection of subtle changes from the eyelids and cornea to the lens and retina.
To screen for glaucoma, the measurement of intraocular pressure is a standard part of a comprehensive exam. For individuals experiencing dryness, specific tests can quantify the issue. The Schirmer’s test, for instance, measures tear production by placing a small strip of filter paper inside the lower eyelid for several minutes. These proactive monitoring procedures enable the early identification of complications.
Treatment and Management Approaches
Managing the eye-related effects of scleroderma involves addressing specific symptoms. For the common issue of dry eyes, over-the-counter lubricating eye drops, or artificial tears, can provide relief. For more persistent dryness, thicker ointments or gels can be used, especially overnight. Prescription medications that increase tear production may also be an option, as can a minor procedure to insert punctal plugs, which block the tear drainage channels.
When eyelid tightening causes incomplete closure, strategies focus on protecting the cornea from exposure, particularly during sleep by using moisture chambers or taping the eyelids shut. For more serious complications like retinopathy or glaucoma, treatment requires collaboration between a rheumatologist and an ophthalmologist. This ensures management of the systemic scleroderma alongside specific treatments, such as medicated eye drops to lower intraocular pressure in glaucoma.