To the Editor.
—I was surprised that the discussion of Wegener's granulomatosis in the Grand Rounds at the National Institutes of Health1 made no mention of the ophthalmic clinical manifestations of this disease. Although the authors listed the eye and orbit as an organ system commonly affected (52% frequency) in Table 1, there was no specific mention of the many clinical ocular features of this disorder. This is surprising because unilateral or bilateral exophthalmos and optic neuritis with blindness are mentioned in the first description of Wegener's granulomatosis and continue to be a common presentation.2 Exopthalmos can coexist with proptosis, eyelid edema, chemosis, limitation of extraocular movements, and exposure keratitis. It is of greatest significance that conjunctivitis can be the initial presentation for patients with this potentially fatal disease.3 In addition, scleritis, episcleritis, and peripheral ring corneal ulcers have been described prior to the development of any
Flach AJ. Ocular Manifestations of Wegener's Granulomatosis. JAMA. 1995;274(15):1199-1200. doi:10.1001/jama.1995.03530150023023