OCULAR MANIFESTATIONS ASSOCIATED WITH SYSTEMIC RHEUMATOLOGIC DISEASES: A SYSTEMATIC REVIEW

Introduction: Systemic rheumatologic diseases frequently present with ocular involvement that may precede, accompany, or follow systemic manifestations, often contributing significantly to morbidity and irreversible visual impairment. Ocular findings can range from mild surface disease to severe inflammatory conditions affecting the uvea, retina, optic nerve, and orbit. Early recognition of these manifestations is essential, as ocular disease activity may reflect systemic inflammation or indicate disease flare. Despite their clinical relevance, ocular complications are often underrecognized outside ophthalmology-centered care. Objective: The main objective of this systematic review was to evaluate the spectrum, frequency, and clinical impact of ocular manifestations associated with systemic rheumatologic diseases. Secondary objectives included assessing diagnostic approaches, therapeutic strategies, visual outcomes, and the level of evidence supporting current management recommendations. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Observational studies and clinical trials published within the last five years were prioritized, with expansion to ten years if fewer than ten eligible studies were identified. Data synthesis followed PRISMA guidelines, and risk of bias and certainty of evidence were assessed using validated tools. Results and Discussion: Twenty studies met the inclusion criteria and were included in the final analysis. The most frequently reported ocular manifestations were uveitis, keratoconjunctivitis sicca, scleritis, episcleritis, retinal vasculitis, and optic neuropathy, with variation according to the underlying rheumatologic disease. Multidisciplinary management and early ophthalmologic referral were consistently associated with improved visual outcomes. The overall certainty of evidence ranged from low to moderate, reflecting heterogeneity in study design and outcome reporting. Conclusion: Ocular manifestations are common and clinically significant complications of systemic rheumatologic diseases, requiring heightened awareness among clinicians. Timely diagnosis and coordinated care between rheumatologists and ophthalmologists are critical to prevent vision loss and optimize patient outcomes.