Rheumatology International

, Volume 39, Issue 3, pp 489–495 | Cite as

Clinical significance of ocular manifestations in granulomatosis with polyangiitis: association with sinonasal involvement and damage

  • Andrea Hinojosa-AzaolaEmail author
  • Annette García-Castro
  • Alejandra Juárez-Flores
  • Claudia Recillas-Gispert
Observational Research


Ocular involvement is present in 50–60% of granulomatosis with polyangiitis (GPA) patients and can affect any part of the ocular globe. The present study describes ophthalmologic manifestations, association with systemic symptoms, disease activity and damage in GPA. A cross-sectional study was conducted including patients with GPA who underwent rheumatologic and ophthalmologic evaluation. Demographics, comorbidities, ophthalmologic symptoms, serologic markers, radiographic studies, disease activity and damage were assessed. Descriptive statistics, correlation, univariable logistic regression analyses, Student’s t, Mann–Whitney U, Chi-square and Fisher’s exact tests were performed. Fifty patients were included, 60% female, the median age was 56 years, disease duration 72.5 months. Nineteen (38%) patients had ocular manifestations at GPA diagnosis, scleritis being the most frequent; 27 (54%) patients presented ocular involvement during follow-up, repeated scleritis and dacryocystitis being the most common manifestations. Concomitant ophthalmic and sinonasal involvement was present in 12 (24%). Ocular and ENT damage occurred in 58% and 70%, respectively. Epiphora and blurred vision were the most frequent symptoms; scleromalacia and conjunctival hyperemia (27%) the most frequent clinical abnormalities. Ocular involvement at diagnosis was associated with concomitant ocular and sinonasal involvement at follow-up (OR 4.72, 95% CI 1.17–19.01, p = 0.01). Ocular involvement at follow-up was associated with age at GPA diagnosis (OR 0.94, 95% CI 0.90–0.99, p = 0.03), VDI (OR 1.29, 95% CI 1.03–1.61, p = 0.02), and ENT damage (OR 5.27, 95% CI 1.37–20.13, p = 0.01). In GPA, ocular involvement is frequent, therefore, non-ophthalmologist clinicians should be aware of this manifestation to reduce the risk of visual morbidity and organ damage.


Granulomatosis with polyangiitis Ocular involvement Sinus involvement Disease activity Damage 



The authors thank Dr. Lauro Quintanilla-González for his assistance in the clinical evaluation of the patients, Dr. Luis Llorente and Professor Clifford E. Roberson for their valuable aid in revising and editing the manuscript.

Author contributions

AHA, AGC and AJF designed the study; AHA, AGC, AJF and CRG participated in acquisition of data; AHA and AGC analyzed and interpreted data; AHA, AGC, AJF and CRG drafted and revised the manuscript and agree to be accountable for all aspects of the work.


The authors declare that this work was not supported by any grant or funding.

Compliance with ethical standards

Conflict of interest

AHA, AGC, AJF and CRG declare that they have no conflict of interest.

Supplementary material

296_2019_4242_MOESM1_ESM.docx (62 kb)
Supplementary material 1 (DOCX 61 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Immunology and RheumatologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
  2. 2.Department of OphthalmologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico

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