Ocular Vascular Involvement in the Rheumatic Diseases

Retinal vascular disease often occurs in conjunction with systemic inflammatory disease, particularly Behcet's disease and Systemic Lupus Erythematosus. In contrast to other manifestations of vasculitides, those affecting the posterior segment of the eye are accessible to direct visualisation by ophthalmoscopy, enabling a number of the features to be distinguished on clinical examination. Retinal vascular disease frequently carries a poor visual prognosis, and macular ischaemia leads to irreversible visual loss. Early disease identification and institution of appropriate management is therefore valuable in reducing the morbidity of these conditions. The vascular manifestations of different rheumatological diseases will be discussed, together with current and emerging therapies, including corticosteroids, second-line immunosuppression and biological agents, as well as the potential role for interferon alpha in the management of Behcet's disease.