Orbital Involvement and Ocular Surface Changes in IgG4-Related Systemic Disease

Area of Science:

• Ophthalmology
• Immunology
• Systemic Inflammatory Diseases

Background:

• Immunoglobulin-G4-related disease (IgG4-RD) is a systemic fibroinflammatory condition with diverse clinical manifestations.
• Ophthalmic involvement is common in IgG4-RD, but its impact on ocular surface parameters and corneal nerves is not fully understood.

Purpose of the Study:

• To investigate the ophthalmic manifestations of systemic IgG4-RD.
• To assess changes in ocular surface parameters and the corneal subbasal nerve plexus in patients with IgG4-RD.

Main Methods:

• A comparative study involving 10 patients with IgG4-RD and 10 healthy controls.
• Ocular surface tests included tear break-up time (BUT), lissamine green (LG) staining, Schirmer I test, and Ocular Surface Disease Index (OSDI) questionnaire.
• In vivo confocal microscopy was used to evaluate corneal subbasal nerves and epithelial cells.

Main Results:

• Orbital involvement was observed in 70% of IgG4-RD patients, presenting as swelling, motility issues, or proptosis.
• Patients with IgG4-RD exhibited significantly higher OSDI and LG scores, and lower BUT and Schirmer values compared to controls.
• Corneal subbasal nerve density and nerve fiber length were significantly reduced in IgG4-RD patients.

Conclusions:

• The orbit is frequently affected in IgG4-RD, necessitating ophthalmic evaluation.
• Ocular surface disease and dry eye are common in IgG4-RD patients, potentially linked to lacrimal gland and/or orbital nerve involvement.