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The use of face masks has become ubiquitous. Although mask wearing is a convenient way to reduce the spread of disease, it is important to know how the mask affects our communication via facial expression. For example, when we are wearing the mask and meet a friend, are our facial expressions different compared to when we are not? We investigated the effect of face mask wearing on facial expression, including the area around the eyes. We measured surface electromyography from zygomaticus major, orbicularis oculi, and depressor anguli oris muscles, when people smiled and talked with or without a mask. Only the actions of the orbicularis oculi were facilitated by wearing the mask. We thus concluded that mask wearing may increase the recruitment of the eyes during smiling. In other words, we can express joy and happiness even when wearing a face mask.

Objective The aim of this study was to investigate cases with ocular complications associated with intravesical BCG therapy in terms of clinical features, demographic features and type of ocular involvement. Methods PubMed database was scanned for relevant publications using the keywords. Thirty-seven publications and 147 reported cases were identified related to the development of ocular complications due to intravesical BCG treatment. Results As a result of the analysis performed according to eye involvement, there were 17 cases of conjunctivitis, 7 uveitis, and 5 endophthalmitis. Only 27 (18.3%) cases were of primary ocular involvement and Reiter's syndrome was present in 120 (81.6%) of all cases. Conclusions Most of the side-effects of BCG therapy are minor and of short duration. Although rare, it has been reported that potentially serious ocular complications can develop after treatment. Physicians must keep these facts in mind and be alert to the development of ocular symptoms following BCG therapy.

espanolLa enfermedad de Behcet es un trastorno inflamatorio cronico recidivante que cursa con brotes y cuya etiologia es incierta. Su prevalencia varia segun el area geografica y la etnia, incrementandose desde el Mediterraneo hacia el Este Asiatico a lo largo de la antigua «ruta de la seda». La manifestacion clinica mas caracteristica son las ulceras orales y genitales, seguidas de otras lesiones cutaneas (eritema nudoso, papulopustuas, etc.) y uveitis. Con menos frecuencia se presenta con artritis, afectacion gastrointestinal, vascular (arterial y venosa) y del sistema nervioso central. Tras los primeros anos desde la presentacion, suele evolucionar de forma favorable, pero la clinica vascular y neurologica, aunque menos comun, puede ser fatal. La afectacion ocular es la principal responsable de dano residual en forma de disminucion de la agudeza visual. Suele comenzar en torno a la tercera decada de la vida y no muestra un predominio claro de sexo, pero suele ser mas grave en el masculino. El tratamiento tiene como objetivo suprimir las exacerbaciones inflamatorias y recurrencias que pueden causar dano organico irreversible. Debe individualizarse segun el fenotipo y la gravedad de la enfermedad. Se fundamenta en la colchicina para la afectacion cutaneomucosa, corticoides, otros inmunosupresores y anticuerpos monoclonales para la clinica mas grave. EnglishBehcet's disease is a chronic relapsing inflammatory disorder that flares and is of uncertain aetiology. Its prevalence varies by geographic area and ethnicity, increasing from the Mediterranean to East Asia along the ancient «Silk Route». Oral and genital ulcers are the most characteristic clinical manifestations, followed by other skin lesions (erythema nodosum, papulopustular lesions, etc.) and uveitis. Less frequently it presents with arthritis, gastrointestinal, vascular (arterial and venous) and central nervous system involvement. After the first few years from onset, the disease usually progresses favourably, but vascular and neurological symptoms, although less common, can be fatal. Eye involvement is primarily responsible for residual damage in the form of decreased visual acuity. It usually starts around the third decade of life and shows no clear gender predominancy, but is usually more severe in males. The aim of treatment is to suppress inflammatory flare-ups and recurrence that can cause irreversible organ damage. It should be tailored to the phenotype and severity of the disease. It is based on colchicine for involvement of the skin and mucosa, corticosteroids, other immunosuppressants and monoclonal antibodies for more severe disease.

Purpose: To investigate the clinical and histopathological features of congenital fibrovascular pupillary membrane (CFPM) in Chinese patients. Methods: This retrospective study reviewed CFPM cases treated at Beijing Children's Hospital. The clinical manifestations, approaches of treatment, outcomes, and histopathological findings were collected and analyzed. Results: A total of 33 patients with CFPM were reviewed. All patients had unilateral eye involvement. A total of 21 eyes (63.64%) had a white membrane that partially covered the pupil and 12 eyes (36.36%) had a membrane that completely covered the pupil. Of the 12 eyes with a complete pupillary membrane, 6 (50%) had glaucoma. For eyes with a partial pupillary membrane, 11 eyes (52.38%) were followed up at the outpatient clinic without surgery and 10 eyes (47.62%) underwent membranectomy and pupilloplasty due to visual axis blockage. For the 12 eyes with a complete pupillary membrane, 6 eyes (50%) with normal intraocular pressure (IOP) received membranectomy and pupilloplasty combined with iridectomy, and 1 (16.67%) of these 6 eyes underwent a reoperation after 5 months due to a recurrent membrane. Furthermore, 6 eyes (50%) with glaucoma had membranectomy, pupilloplasty, iridectomy, and goniosynechialysis. Among these 6 eyes, 2 eyes (33.33%) underwent a reoperation due to the recurrence of a membrane and 4 eyes (66.67%) had a pale optic disc. The histopathological findings revealed that these membranes were mainly composed of fibrous tissue, lymphocytes, pigment epithelial cells, and vascular tissues. Conclusions: CFPM has diverse manifestations, including a partial pupillary membrane, a complete pupillary membrane with normal IOP, and a complete pupillary membrane with glaucoma. Timely diagnosis and treatment are critical when the visual axis is blocked and/or the IOP is high. [ J Pediatr Ophthalmol Strabismus . 2021;58(2):105–111.]

Purpose of review This article summarizes the systemic and ocular manifestations of Blau syndrome, its genetic basis, and reviews recently published literature. Recent findings A large multicenter prospective case series is underway, with 3-year preliminary results indicating the prevalence of uveitis, clinical characteristics and early data on its visual prognosis. Case reports have demonstrated the successful use of newer biologic agents. Summary Blau syndrome is an exceedingly rare autoinflammatory disorder with skin, joint and eye manifestations. It is caused by autosomal dominant mutations of the NOD2 protein. Eye involvement is typically a chronic bilateral granulomatous iridocyclitis, often with multifocal choroiditis in the posterior segment. Treatment starts with topical and systemic steroids and often requires antimetabolites or biologic agents.

Background Incontinentia pigmenti (IP) is a rare multisystemic X-linked dominant genetic disorder characterized by highly diagnostic skin lesions. The disease can be misdiagnosed in infants, and complications affecting the eyes and/or the brain can be severe. Our objective was to highlight the urgency of an appropriate diagnosis and management strategy, as soon as the first symptoms appear, and the need for a well-codified monitoring strategy for each child. Methods An in-depth literature review using a large number of databases was conducted. The selection criteria for articles were literature review articles on the disease, case series and retrospective studies based on the disease, clinical studies (randomized or not) on treatment, articles discussing patient care and management (treatment, diagnosis, care pathways), and recommendations. The research period was from 2000 until 2018. A group of multidisciplinary experts in IP management was involved, issued from different healthcare providers of the European Network for Rare Skin Diseases (ERN-Skin). The final recommendations have been submitted to two patient representative associations and to a general practitioner and a neonatal specialist prior to their finalization. Results and conclusion The diagnosis of IP must be promptly performed to detect potential extracutaneous manifestations, thus allowing the timely implementation of specific therapeutic and monitoring strategies. Eye involvement can be a therapeutic urgency, and central nervous system (CNS) involvement requires a very rigorous long-term follow-up. Assessments and patient support should take into account the possible co-occurrence of various symptoms (including motor, visual and cognitive symptoms).

to study the association between asteroid hyalosis and diabetes mellitus.: This study was carried out in the Department of Ophthalmology, MLB Medical College, Jhansi between February 2019- December 2019 on patients diagnosed with asteroid hyalosis on routine examination. A total of 80 patients who showed evidence of asteroid hyalosis were further sent for random blood sugar and HbA1c levels. They were then divided into two groups-group A was diabetic and group B-non diabeticThe median age of presentation was between 40-75 years. 80 patients diagnosed with asteroid hyalosis were divided into two groups; Group A with diabetes and Group B without diabetes. In Group A there were 68.42% males (13) and 31.58% females (6) and in Group B there were 70.50% males (43) and 29.50% females(18). In group A 63.16% (12) patients showed unilateral eye involvement and 36.84% (7) patients showed bilateral eye involvement while in group B 80.33%(49) patients showed unilateral eye involvement and 19.67% (12) patients showed bilateral involvement. The mean random blood sugar was found to be 239.26±38.37 mg/dl in group A while in group B it was found to be 132.31±26.26 mg/dl. The p-value was found to be There appears to be significant association between asteroid hyalosis and diabetes mellitus.

Neurological research and practice 3, 57 (2021). doi:10.1186/s42466-021-00155-8, Published by BioMed Central, [London]

Hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) is characterized by vesiculopapular eruptions on sun-exposed and sometimes unexposed skin. Though ocular involvement in HVLPD is rare, it may present with conjunctivitis, corneal opacities, uveitis, and interstitial keratitis. We report a case of a 7-year-old boy with HVLPD, whose ophthalmic symptoms were neglected for over 2 years, who developed anterior uveitis and corneal nebulae without vision impairment. Awareness of eye involvement in patients with HVLPD may help to prevent severe complications.

We report a patient with complex clinical presentation including multiple neurological symptoms and eye involvement. Upon genetic investigation, the patient was found to carry a novel homozygous mutation in the NDUFS4 gene, thus adding to the heterogeneity of Leigh syndrome clinical presentation.

Eye involvement in psoriasis is little known to many dermatologists, although psoriasis has been acknowledged as a systemic disease for decades. The ophthalmic complications of psoriasis are numerous and can affect almost any part of the eye. The most common ocular changes in patients with psoriasis, including blepharitis, conjunctivitis, keratitis, iridocyclitis, UV-induced cataracts, uveitis, and birdshot chorioretinitis, have been described in the literature. Recognition of the ocular complications of psoriasis is of significant clinical importance, because various pathogenic mechanisms may contribute to the development of ocular manifestations, including direct eye involvement with psoriatic plaques, psoriasis-related immune-mediated inflammatory processes, and complications of psoriasis treatments.

Sowohl die Riesenzellarteriitis (RZA) als auch die Takayasu-Arteriitis sind Formen der Grosgefasvaskulitis und konnen sich am Auge manifestieren. Wahrend die RZA Patienten ab dem 50. Lebensjahr trifft, sind die Patienten bei der Takayasu-Arteriitis zwischen 15 und 30 Jahren alt. Die Diagnose wird aus der Kombination von Anamnese, Bildgebung und systemischer Entzundungsreaktion gestellt. Durch eine Biopsie kann die Diagnose bestatigt werden. Typische Augenbeteiligungen der RZA sind eine anteriore ischamische Optikusneuropathie (AION) oder ein Zentralarterienverschluss, bei der Takayasu-Arteriitis sind es das Bild einer hypertensiven Retinopathie oder einer Takayasu-Retinopathie (Kapillarerweiterungen, Mikroaneurysmata, arteriovenose Anastomosen). Die Therapie besteht aus Steroiden in Kombination mit klassischen Immunsuppressiva oder Biologika.

Aim: The aim of this study was to determine the demographic, clinical, treatment, and outcome features of pediatric noninfectious uveitis patients at a Turkish tertiary center.Materials and methods: This retrospective cohort study included 101 pediatric patients with noninfectious uveitis. Location of uveitis, laterality, age at onset of uveitis, complications of uveitis, duration of follow-up, associated systemic diseases, laboratory findings, medications used, and status of uveitis at the time of data collection were obtained from the patients' files. The patients were divided into two groups according to etiology of uveitis, as follows; group 1: idiopathic noninfectious uveitis; group 2: noninfectious uveitis in association with an underlying systemic disease. Clinical findings were compared between the two groups.Results: Mean age at diagnosis of uveitis was 9.36 ± 4.24 years and mean duration of follow-up was 48.4 ± 9.2 months. Anterior uveitis was the most common form, accounting for 69.3% (n = 70) of the patients. There were 67 (66.3%) patients in group 1 and 34 (33.7%) patients in group 2. Mean age at diagnosis of uveitis was lower in group 2 (p < 0.05). Although gender, type of inflammation, laterality of eye involvement, and mean age at initiation of biological treatment did not differ between the groups; symptomatic uveitis was more common in group 1, whereas anterior uveitis was also more common in group 2 (p < 0.05). At the time of data collection 16 (15.8%) of the patients had active uveitis. Ocular complications were observed fewer in idiopathic noninfectious uveitis group than noninfectious uveitis associated with an underlying systemic disease (p < 0.05). Biological therapy was administered in 26.8% of the patients in group 1, versus 67.6% of those in group 2. Ocular complications were observed in 22.8% of the patients at presentation or during the follow-up.Conclusion: Herein a large retrospective cohort of noninfectious pediatric uveitis has been described. The findings indicate that noninfectious idiopathic uveitis is characterized by more symptomatic, later onset, and fewer complications than noninfectious uveitis associated with an underlying systemic disease.

AIM: To evaluate the atherogenic indices and the relationship with visual acuity and bilateral sequential involvement in patients with non-arteritic ischemic optic neuropathy (NAION). METHODS: A total of 65 patients with NAION and 48 age-sex matched healthy individuals were included in this retrospective study. The demographic characteristics and laboratory findings of the patients and control subjects were obtained from the electronic medical records. The atherogenic indices were calculated using the lipid parameters. The association between visual acuity, bilateral sequential involvement, and atherogenic indices was investigated. RESULTS: The mean age was 63.8±12.5y in the NAION group and 64.7±10.1y in control group (P=0.707). Although there were no significant differences in terms of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) between two groups (P=0.089, 0.091), all the non-traditional serum lipid ratios were significantly higher in NAION group (P20/200 (P=0.032, 0.025, 0.032, respectively). The values for the atherogenic indices were higher in NAION patients with bilateral sequential involvement in comparison to those with unilateral involvement (P=0.271, 0.127, 0.197, 0.128, 0.127, respectively). CONCLUSION: The study reveals a relationship between NAION and the non-traditional lipid ratios. Atherogenic indices may predict the visual loss severity and second eye involvement in patients with NAION.

ObjectiveThere is a broad spectrum of eye involvement in antiphospholipid syndrome (APS). The majority of descriptions are presented as case reports that include mostly APS patients secondary to systemic lupus erythematosus (SLE), with no compelling evidence in primary APS (PAPS). This study aimed to describe ocular manifestations in our well-defined PAPS cohort (APS-Rio) and then perform a systematic literature review (SLR) of ocular manifestations in patients with APS or positivity to aPL without SLE.MethodsWe retrospectively analyzed PAPS patients followed at our outpatient clinics. All patients fulfilled Sydney APS classification criteria (2006). We evaluated them for ocular symptoms and previous ocular diagnoses. Antiphospholipid antibodies and clinical APS manifestations were compared between patients with and without ocular manifestations. For the SLR, electronic databases were searched up to November 2019.ResultsWe studied 105 PAPS patients; 90.5% were female and 56.2% were Caucasian. We found ocular manifestations in 37.1% of our cohort. Thrombosis was the main criteria manifestation (95.2%) and lupus anticoagulant was the most prevalent antibody. Ophthalmologic diagnoses were present in 7 patients, with 5 having retinal vessels thromboses. Amaurosis fugax was the leading complaint, present in 30 patients. In the univariate analysis, amaurosis fugax was related to livedo (p = 0.005), Raynaud’s phenomenon (p = 0.048) and the presence of anticardiolipin antibody (≥40 GPL/MPL) (p = 0.041). Hemianopia was associated with arterial hypertension (p = 0.049). In the multivariate analysis, the only association found was between livedo and amaurosis fugax (OR 4.09, 95%CI 1.5–11.11, p = 0.006). Our SLR incorporated 96 articles of ocular manifestations in patients with PAPS or positivity to aPL without SLE. Ocular findings varied from 5 to 88%, including anterior and posterior segments, orbital and neuro-ophthalmologic changes.ConclusionThere is little evidence on ocular manifestations in PAPS. We described an association between livedo and amaurosis fugax. Prospective studies are needed to promote the best treatment and avoid blindness in PAPS patients.

Systemic lupus erythematosus (SLE) is a chronic, autoimmune, multisystem disease associated with a variable clinical course. SLE is more severe and is associated with higher mortality in children compared to adults. Eye involvement may be seen in up to a third of patients. Retinal vasculopathy is rare in children with SLE. We report two such cases. Both patients in this series had cotton-wool spots on fundus examination, and fundus fluorescein angiography revealed findings of occlusive micro-angiopathy. These findings are characteristic of lupus retinal vasculopathy. Fundus examination is crucial in diagnosing retinal vasculopathy. All children with SLE must be evaluated in detail to detect any retinal abnormalities and should be managed with aggressive immunosuppression to save their vision.

Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial.

Background/AimsNeovascular age-related macular degeneration (nAMD) is frequently bilateral, and previous reports on ‘fellow eyes’ have assumed sequential treatment after a period of treatment of the first eye only. The aim of our study was to analyse baseline characteristics and visual acuity (VA) outcomes of fellow eye involvement with nAMD, specifically differentiating between sequential and non-sequential (due to macular scarring in the first eye) antivascular endothelial growth factor treatment and timelines for fellow eye involvement.MethodsRetrospective, electronic medical record database study of the Moorfields AMD database of 6265 patients/120 286 single entries with data extracted between 21 October 2008 and 9 August 2018. The data set for analysis consisted of 1180 sequential, 807 non-sequential and 3410 unilateral eyes.ResultsMean VA (ETDRS letters±SD) of sequentially treated fellow eyes at baseline was significantly higher (63±13), VA gain over 2 years lower (0.37±14) and proportion of eyes with good VA (≥70 letters) higher (46%) than the respective first eyes (baseline VA 54±16, VA gain at 2 years 5.6±15, percentage of eyes with good VA 39%). Non-sequential fellow eyes showed baseline characteristics and VA outcomes similar to first eyes. Fellow eye involvement rate was 32% at 2 years, and median time interval to fellow eye involvement was 71 (IQR: 27–147) weeks.ConclusionThis report shows that sequentially treated nAMD fellow eyes have better baseline and final VA than non-sequentially treated eyes after 2 years of treatment. Sequentially treated eyes also had a greater proportion with good VA after 2 years.

Copyright © 2020, International League of Associations for Rheumatology (ILAR), Giant cell arteritis (GCA) is a granulomatous vasculitis involving large- and middle-sized arteries, with a predilection for cranial arteries. In this paper, we aim to describe a case of a biopsy- and ultrasound-proven GCA, presenting with anterior ischemic optic neuropathy (AION) and normal CRP and ESR at diagnosis and during follow-up, and to review the literature on GCA cases with low inflammatory markers, with a particular focus on the presence of eye involvement. Both CRP and ESR are important in the diagnosis of GCA; occurrence of this disease with normal acute phase reactants is unusual but does not rule out the diagnosis. Headache and visual manifestations were the most common symptoms reported in these cases; therefore, patients with the clinical suspicion of GCA require immediate ultrasound and/or temporal artery biopsy for correct diagnosis and treatment initiation in order to avoid permanent visual loss.

Background To explore the effects of enhanced external counterpulsation (EECP) and its underlying influencing factors in nonarteritic anterior ischemic optic neuropathy (NAION) patients. Methods Patients at Zhongshan Ophthalmic Center with recent-onset ( Results In total, 61 patients (76 eyes) were included. Twenty-nine patients (37 eyes) underwent EECP treatment, while 32 patients (39 eyes) were included in the control group. Mean time from NAION onset to EECP initiation was 27.59 ± 16.70 days. In the EECP group, the mean EECP duration was 31.57 ± 18.45 days. EECP was well tolerated by all patients. However, there was no significant difference in visual function between the EECP and control groups. Furthermore, there was no evidence of the effectiveness of EECP in the subgroup analysis of patients with different systemic health conditions. Among the 42 patients with monocular NAION, the sequential attack rate was comparable between the EECP (27.78%) and control (25.00%) groups. Conclusion This study is the first nonrandomized controlled study to evaluate the effectiveness of EECP in NAION patients. Unfortunately, we failed to demonstrate the effectiveness of EECP in NAION at the 6-month follow-up. Any further application of EECP in NAION patients should be cautious.

Some systemically used drugs in managing dermatologic disorders have associated severe side effects, of which eye involvement is very significant. There are various mechanisms for these drugs to cause damage to the eye. The damage to the eye can be acute as in Stevens–Johnson syndrome or chronic as with chloroquine and hydroxychloroquine toxicity. Knowledge about these drugs and information about the mechanisms and types of damage to the eye are essential. It is also important to understand the monitoring mechanisms to diagnose early and limit the damage. Newer investigative tools, especially the imaging techniques help us to diagnose the adverse effects at an early stage. All these issues are discussed in brief here.

The pandemic of COVID-19, named by World Health Organization (WHO) SARS –CoV-2, revealed a novel type of corona virus. Gradually, starting from December 2019 in China, the data about the symptoms and systemic involvement started to be collected from medical centers all over the world. As far as now, it is known that the virus involves upper respiratory tract , lungs, kidneys, gastrointestinal system, coagulation system, brain and eye. In this review we present the clinical aspects of the eye and findings in patients hospitalized with severe condition as result of SARS-CoV-2 infection. There are reports of sporadic cases of people who presented conjunctivitis which is called "pink eye". According to different sources of information, the eye is involved in COVid-19 pandemic in 1% - 3% of cases actively involved.

The management of nonarteritic anterior ischemic optic neuropathy centers around prevention of second eye involvement, without a uniformly accepted therapy for the involved eye. Several researchers have assessed the benefit of steroids with conflicting results. This experimental study was designed to evaluate the efficacy of a single intravitreal triamcinolone acetonide injection (IVTA) in preserving retinal ganglion cells (RGCs) in a rodent model of anterior ischemic optic neuropathy (rAION).The rAION was induced in female Wistar rats. Animals were randomized into 3 groups: 1) untreated, 2) treated with 56 μg IVTA, and 3) intravitreal saline (placebo). Procedures were performed in the left eye, with the right eye serving as control. After 30 days, animals were sacrificed and eyes were assessed histologically for RGC number.The average number of RGC was significantly lower in rAION subgroups when compared with the control group (P0.001). No significant difference was seen between rAION eyes treated with IVTA, placebo, and untreated eyes (P0.05%).In this rodent model for AION, no therapeutic benefit of intravitreal steroid injection was identified.

The mucopolysaccharidoses (MPS) are clinically similar but also heterogeneous in terms of major or minor involvement of different organs/systems, burden of disease, and rate of progression. The attenuated forms of MPS, due to their less severe presentations, are more difficult to diagnose and often receive a significantly delayed diagnosis. On the other hand, the diagnosis is very important since the attenuated forms may benefit from earlier treatments. The aim of this paper is to describe the natural history and the clinical signs useful to arise a suspicion of an attenuated form of MPS. MPS patients usually show a cluster of signs and symptoms, one of which may be the trigger for an evaluation by a specialist. Individuals with attenuated MPS are mostly cognitively normal, and dysmorphisms of the facies may be mild or absent. The most frequently involved organs/systems are the osteoarticular system, heart, and eyes. These patients may also have hepatosplenomegaly, hearing loss, and respiratory problems. When they are referred to a specialist (rheumatologist, cardiologist, ophthalmologist, surgeon, orthopedist, etc.) for their main complaint, the other signs and symptoms are likely to be missed in the medical history. To avoid missing data and to save time, we propose a semistructured medical history form to be filled in by the patients or their caregivers while waiting for evaluation by a specialist.

The main objective of this study was to evaluate the clinical features of ocular sarcoidosis. The second aim was to assess the influence of eye involvement on the prognostic outcome, extrapulmonary organ, and endobronchial involvement in sarcoidosis patients. Third objective was to determine the contribution of ocular involvement to final diagnosis in patients presenting with an equivocal sarcoidosis diagnosis due to single organ disease.

Objective: To assess the efficacy and safety of treatment modalities for major organ involvement of Behçet's syndrome (BS), in order to inform the update of the EULAR recommendations for the management of BS.Methods: A systematic literature review of all randomized controlled trials, controlled clinical trials, or open label trials assessing eye, vascular, nervous system or gastrointestinal system involvement of BS was performed. If controlled trials were not available for answering a specific research question, uncontrolled studies or case series were also included.Results: We reviewed the titles and abstracts of 3927 references and 161 studies met our inclusion criteria. There were only nine randomized controlled trials. Observational studies with IFN-α and monoclonal anti-TNF antibodies showed beneficial results for refractory uveitis. Meta-analysis of case-control studies showed that immunosuppressives decreased the recurrence rate of deep vein thrombosis significantly whereas anticoagulants did not. CYC and high dose glucocorticoids decreased mortality in pulmonary arterial aneurysms and postoperative complications in peripheral artery aneurysms. Beneficial results for gastrointestinal involvement were obtained with 5-ASA derivatives and AZA as first line treatment and with thalidomide and/or monoclonal anti-TNF antibodies in refractory cases. Observational studies for nervous system involvement showed improved outcome with immunosuppressives and glucocorticoids. Meta-analysis of case-control studies showed an increased risk of developing nervous system involvement with ciclosporin-A.Conclusion: The majority of studies related to major organ involvement that informed the updated EULAR recommendations for the management of BS were observational studies.

Psoriatic arthritis (PsA) is characterized by a wide spectrum of articular and extra-articular clinical manifestations including peripheral arthritis, spondylitis, enthesitis, dactylitis, skin and eye involvement, and systemic features such as metabolic syndrome and cardiovascular ischemic disease. The diverse clinical picture of PsA suggests the need to identify suitable therapies to address the different combinations of clinical manifestations. Given the heterogeneity PsA, the treatments should be tailored to individual cases

Pemphigus vulgaris PV is a bullous disease It has autoimmune etiology It mainly affects skin along with mucous membranes The frequency and pattern of involvement of eyes in this disease is not clearly defined till now We decided to conduct a study of hundred patients with diagnosis of PV in a tertiary care hospital in Pakistan The result showed a significant number of patients with eye involvement out of cases in the indoor department of hospital i e showed eye involvement in a variable range of severity and presentation Most common symptom was conjunctivitis followed by palpebral conjunctival erosions Discharge was present in few patients that was either watery or mucoid due to the secondary infection

The most prevailing extraarticular common complication is eye involvement in patients with ankylosing spondylitis (AS), while it is reported that approximately 25–40% patients suffer from acute anterior uveitis, which may occur at any time during the disease course1. A 46-year-old man presented with no sight in his right eye for 2 years and was referred to our hospital. Anterior segment photography was done …