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Kelly Williamson, Enrique Aradillas Lopez, Majda Hadziahmetovic, Jessica M Ackert; Increased Risk of Ophthalmic Disease in Patients with Complex Regional Pain Syndrome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1865.
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Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), is a condition characterized by chronic, and disproportionate, pain in response to an inciting stimulus. The pathophysiology is poorly understood, and includes increased nervous system sensitization, motor disturbance, and dysregulation of the autonomic nervous system. More recently immune system dysfunction and inflammation have been implicated as a potential contributing factors. To the best of our knowledge, the prevalence of concomitant ophthalmologic symptoms has never been reported in the literature. Here we report a cohort of patients, previously diagnosed with CRPS, referred for ophthalmic examination and found to a high rate of ophthalmic disease including a higher than expected prevalence of have immune-related eye disease.
Retrospective case review.
Patients diagnosed with CRPS by specialists at Drexel College of Medicine were referred for ophthalmic evaluation. Five patients total with a diagnosis of CRPS had ophthalmic symptoms and were referred for ophthalmology consultation. The most common complaints upon evaluation were redness and pain. Visual acuities at presentation ranged from 20/25 to light perception. A majority of patients were diagnosed with dry eye syndrome as evaluated by questionnaire, clinical examination, and Schirmer’s testing. 2 patients were found to have immune-modulated eye disease, 1 with sectoral anterior scleritis and another with severe sclerokeratitis. 1 patient with anterior scleritis had a skin biopsy which was positive for small-fiber polyneuropathy.
RSD is a poorly understood and multi-faceted disease process. Our small study suggests patients diagnosed with RSD may be at increased risk of ophthalmic complications. Additionally, patients who found to have a biopsy positive for small vessel vasculitis may be at increased risk of developing scleritis. Though our n is low, patients with scleritis and RSD required therapeutic escalation to immunomodulatory agents to control their eye disease. Further study is needed to examine these observations further.
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