1
|
Poondru S, Alvi S, LeWitt TM, Haddadin R, Kundu RV. Ocular findings in vitiligo and recommendations for dermatologists. Int J Dermatol 2023; 62:1433-1436. [PMID: 37919864 DOI: 10.1111/ijd.16883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
Since extracutaneous melanocytes in the eye may also be affected in vitiligo, a systematic review was conducted to explore the ocular manifestations of vitiligo. Studies point to a higher risk of ocular findings in periorbital vitiligo. Dry eye disease is the most reported ocular abnormality in vitiligo. Additionally, several small studies have found potential links to uveitis and glaucoma. Various other chorioretinal pigmentary changes are also reported, but without accompanying functional consequences or changes in vision. Although there is a need for larger studies to further elucidate these associations, dermatologists should be aware of potential ocular comorbidities in vitiligo and refer to ophthalmology accordingly.
Collapse
Affiliation(s)
- Sneha Poondru
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Saira Alvi
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tessa M LeWitt
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ramez Haddadin
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roopal V Kundu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
2
|
LeWitt T, Tauscher R, Obiofuma G, Peterson J, Haddadin R, Kundu RV. Ocular manifestations of vitiligo: a systematic review. BMC Ophthalmol 2023; 23:120. [PMID: 36973683 PMCID: PMC10041747 DOI: 10.1186/s12886-023-02777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/11/2023] [Indexed: 03/29/2023] Open
Abstract
Vitiligo is a disorder characterized by loss of epidermal melanocytes, resulting in depigmented macules and patches. While the relationship between ocular pathology and vitiligo has been demonstrated in conditions such as Vogt-Koyanagi-Harada and Alezzandrini syndromes, the ocular associations of non-syndromic vitiligo are incompletely understood. We conducted a systematic review to comprehensively describe the structural and functional changes seen in the eyes of patients with vitiligo, to identify patients at heightened risk for ocular disease, and to provide an approach to management of ocular manifestations of vitiligo. Overall, the strongest link between vitiligo and ocular pathology seems to lie with dry eye disease and pigmentary abnormalities of various ocular structures, especially the retinal pigment epithelium. Normal-tension glaucoma may also be more prevalent in the vitiligo population. The available literature did not provide conclusive evidence for increased risk of cataracts or uveitis. Aside from the impact of symptomatic dry eye disease, it seems unlikely that there are significant functional consequences of these ocular manifestations such as impaired visual acuity or visual fields.
Collapse
Affiliation(s)
- Tessa LeWitt
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert Tauscher
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gracious Obiofuma
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonna Peterson
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, IL, Chicago, USA
| | - Ramez Haddadin
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roopal V Kundu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
3
|
Taheri AR, Nikandish M. Reply to Letter to the Editor re: Dry Eye and Meibomian Glands in Vitiligo. Turk J Ophthalmol 2022; 52:155-156. [PMID: 35481739 PMCID: PMC9069088 DOI: 10.4274/tjo.galenos.2022.60662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/12/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ahmad Reza Taheri
- Mashhad University of Medical Sciences, Department of Dermatology, Mashhad, Iran
| | - Malihe Nikandish
- Birjand University of Medical Sciences, Department of Ophthalmology, Birjand, Iran
| |
Collapse
|
4
|
Ma SH, Wu PC, Chang JY, Chang YT, Dai YX. Ocular Abnormalities in Patients with Vitiligo: A Systematic Review and Meta-Analysis. Dermatology 2022; 238:813-822. [PMID: 35378530 DOI: 10.1159/000522601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitiligo is a skin depigmentation disorder that results from the autoimmune destruction of cutaneous melanocytes. Several ocular abnormalities, including uveitis, dry eye, glaucoma, and retinal diseases, have been reported in patients with vitiligo. The aim of our study was to investigate the association of ocular abnormalities with vitiligo. METHODS This meta-analysis was registered in PROSPERO (CRD42021224167) and adhered to MOOSE checklist and PRISMA guidance for all processes. PubMed, Embase, Web of Science, and Cochrane databases were searched for studies examining the association between ocular abnormalities and vitiligo from inception to December 10, 2020. Studies recruiting patients with Sjogren's syndrome or Vogt-Koyanagi-Harada syndrome were excluded. The primary outcomes were the Schirmer test, tear film break-up time (TBUT), and ocular surface disease index (OSDI) of vitiligo patients compared to the controls. The risk of bias of the selected studies was assessed using the Newcastle-Ottawa Scale (NOS) of case-control studies. RESULTS This meta-analysis of 16 case-control studies showed that patients with vitiligo had significantly lower Schirmer test values (mean difference [MD], -1.65; 95% CI, -2.81 to -0.49), shorter TBUTs (MD, -4.66; 95% CI, -7.05 to -2.26), higher ocular surface disease indices (MD, 18.02; 95% CI, 5.7-30.35), and thinner subfoveal choroidal thicknesses (MD, -53.10; 95% CI, -69.84 to -36.36). No significant differences were found in the prevalence of glaucoma and the level of intraocular pressure. CONCLUSIONS Our study supports an association between dry eye and thinner subfoveal choroidal thickness in patients with vitiligo. Dermatologists should be aware of these possible comorbidities and refer vitiligo patients with ocular symptoms to ophthalmologists for further management.
Collapse
Affiliation(s)
- Sheng-Hsiang Ma
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Chien Wu
- School of Medicine, Taipei Medical University, Taipei, Taiwan, .,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan,
| | - Jin-Yu Chang
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
5
|
Uribe-Reina P, Muñoz-Ortiz J, Cifuentes-González C, Reyes-Guanes J, Terreros-Dorado JP, Zambrano-Romero W, López-Rojas C, Mantilla-Sylvain F, Mantilla-Hernández RD, de-la-Torre A. Ocular Manifestations in Colombian Patients with Systemic Rheumatologic Diseases. Clin Ophthalmol 2021; 15:2787-2802. [PMID: 34234401 PMCID: PMC8254180 DOI: 10.2147/opth.s306621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose To establish the prevalence of ocular involvement in a Colombian population with rheumatologic diseases. Design Observational cross-sectional study. Methods We included a probabilistic sample size of 797 patients who attended a rheumatologic disease center in Bogotá, Colombia. Statistical analysis with descriptive measures and Chi-square independence test between rheumatologic diseases and ophthalmological symptoms and diseases was performed. Results Eighty-four percent of the population were women, and the mean age was 54.61± 15.64 years. The most common condition was rheumatoid arthritis (33.37%), followed by fibromyalgia (22.71%), Sjögren Syndrome (19.72%), and systemic lupus erythematosus (9.91%). Almost 7% of the patients presented polyautoimmunity. Thirty-five percent of the patients reported one or more ophthalmological symptoms, being dry eye sensation the most common (30.86%), followed by ocular pain (2.76%), red-eye, and decreased visual acuity (both 2.63%). Similarly, 21.45% of the patients presented one or more ophthalmological diagnoses, being keratoconjunctivitis sicca the most common (15.93%), followed by cataract, uveitis (1.38% each), and scleritis (1.25%). Conclusion Almost a third of the patients reported any ocular involvement. It is crucial to be aware of the most common ophthalmic manifestations among the different rheumatologic diseases in our population, to offer early specialist referral and timely treatment.
Collapse
Affiliation(s)
- Pilar Uribe-Reina
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.,Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Juliana Muñoz-Ortiz
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.,Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Juan Pablo Terreros-Dorado
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Zambrano-Romero
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.,Fundación Para la Investigación en Dermatología y Reumatología (FUNINDERMA), Bogotá, Colombia
| | - Carolina López-Rojas
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Fabien Mantilla-Sylvain
- Fundación Para la Investigación en Dermatología y Reumatología (FUNINDERMA), Bogotá, Colombia
| | | | - Alejandra de-la-Torre
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
6
|
Abstract
Objectives To evaluate aqueous and lipid tear film parameters and the meibomian glands (MGs) with non-contact meibography in patients with vitiligo. Materials and Methods This case-control study was conducted in the right (OD) and left (OS) eyes of 43 patients with vitiligo and 43 controls in Birjand, Iran. In addition to demographic information and skin disease characteristics, the Ocular Surface Disease Index (OSDI) questionnaire was completed for each patient, followed by eye examinations including slit lamp examination, Schirmer test, strip meniscometry (SMTube), and tear break-up time (TBUT) measurement. The MGs were also imaged using a non-contact meibography system (SBM System, Italy). The data were analyzed using SPSS version 22.0 with a significant level of less than 0.05. Results Patients had higher OSDI score than controls but it was not significant (10.90±13.03 vs. 5.57±6.85; p=0.07). There were significant differences between the groups in mean Schirmer test values for both eyes (OD: 8.07±5.47 vs. 17.37±6.52; OS: 7.60±5.00 vs. 17.30±6.44, p<0.001) and mean SMTube results (OD: 4.49±2.40 vs. 9.74±3.67; OS: 4.30±2.81 vs. 9.65±4.52; p<0.001). However, mean TBUT did not differ between the groups (OD: 9.14±3.17 vs. 10.12±2.08, p=0.27; OS: 9.16±3.30 vs. 10.05±2.10, p=0.25). Meibography also showed no significant difference in MG dropout between the groups (OD: 20.86±9.79 vs. 21.05±12.07; p=0.74; OS: 18.16±8.83 vs. 19.53±10.30; p=0.51). Conclusion Vitiligo is associated with a reduction in the production of aqueous tear film, but does not affect the structure and function of the MGs.
Collapse
Affiliation(s)
- Ahmad Reza Taheri
- Mashhad University of Medical Sciences, Cutaneous Leishmaniasis Research Center, Mashhad, Iran
| | - Elahe Allahyari
- Birjand University of Medical Sciences School of Health, Social Determinants of Health Research Center, Department of Epidemiology and Biostatistics, Birjand, Iran
| | - Borhan Haghi Rudi
- Birjand University of Medical Sciences Valiasr Hospital, Department of Ophthalmology, Birjand, Iran
| | - Malihe Nikandish
- Birjand University of Medical Sciences Valiasr Hospital, Department of Ophthalmology, Birjand, Iran
| |
Collapse
|
7
|
Evaluation of dry eye and meibomian gland dysfunction with meibography in vitiligo. Eye (Lond) 2017; 31:1074-1077. [PMID: 28282067 DOI: 10.1038/eye.2017.38] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/07/2017] [Indexed: 01/16/2023] Open
Abstract
PurposeTo evaluate the dry eye and meibomian gland dysfunction (MGD) of vitiligo patients with meibography.MethodsTwenty eyes of 20 vitiligo patients (Group 1) and 20 eyes of 20 healthy individuals (Group 2) were enrolled. All subjects had undergone a comprehensive ophthalmic examination including corneal and conjunctival fluorescein staining (Oxford scale scoring), tear film break-up time (T-BUT), Schirmer 1 test, Ocular Surface Disease Index (OSDI) score assessment, and upper and lower eyelid meibography using infrared captures of a biomicroscope (Topcon, SL-D701, IJssel, The Netherlands). Partial or complete loss of the meibomian glands was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area was >2/3 of the total meibomian gland area).ResultsThe mean ages of Group 1 and Group 2 were 35.5±13.4 (range, 8-54) and 35.2±12.4 years (range, 8-52), respectively (P=0.942). Mean Schirmer 1 values were lower, and Oxford score, OSDI score, and meiboscores of lower eyelids were higher in Group 1, but the difference was not statistically significant (P=0.139, P=0.057, P=0.071, P=0.300, respectively). T-BUT values were significantly lower, and meiboscores of upper eyelids and total (upper+lower) eyelids were significantly higher in Group 1 than in Group 2 (P=0.047, P=0.001, P=0.003, respectively).ConclusionVitiligo can be associated with dry eye and there are significant differences in meibomian gland morphology in patients with vitiligo when compared with healthy subjects. For this reason, patients with vitiligo should be monitored for dry eye and MGD, and promptly start treatment when needed.
Collapse
|