系统性红斑狼疮（systemic lupus erythematosus，SLE）是一种全身性自身免疫病，因多种自身抗体及血管炎的存在，患者可出现多器官、系统的受累。除脑、肺、心、肾等重要脏器外，还可出现眼部病变。眼部受累表现形式多样，从眼表到眼底疾病均可出现，其中以视网膜受累最为常见，也可出现巩膜受累。广义的巩膜炎包括表层巩膜炎及巩膜炎，其作为临床上一种相对少见的眼部疾病，发病率仅占眼部疾病总数的0.5%左右［1］。因SLE合并巩膜受累发病率低，多为个案报道，临床重视不足。但因巩膜受累可作为SLE的首发表现，且其常可引起多种急、慢性眼部并发症，如治疗不当可导致视力下降或眼球破坏，因此，识别表层巩膜炎及巩膜炎背后的SLE并尽早开始规范诊治尤其重要。本研究复习了4例于北京大学人民医院住院期间诊断为SLE继发表层巩膜炎或巩膜炎的病例，对其临床特点进行分析，并进行文献复习，为临床工作提供一定参考。

Episcleritis and scleritis are relatively rare ocular diseases, which are commonly associated with rheumatic diseases including systemic lupus erythematosus (SLE). To investigate clinical and laboratory features of SLEassociated episcleritis and scleritis, we now report 4 cases of inpatients who were diagnosed with episcleritis or scleritis secondary to SLE from September 2005 to July 2016 in the Department of Rheumatology and Immunology in Peking University People’s Hospital. Demographic, clinical and laboratory characteristics were summarized together with the treatment regimen and the prognosis; the literature was reviewed. There were 3 female and 1 male patients. The average age was (49.0±23.8) years and the mean duration of SLE at the onset of episcleritis or scleritis was (2.1±1.4) years. In addition to the eye involvement, the patients had mucocutaneous manifestations, serositis, lupus nephritis and interstitial pneumonia simultaneously;  in the past, 1 patient experienced arthritis, 2 presented Raynaud’s phenomenon, and 2 had hematologic involvement. All the patients had antinuclear antibody (ANA) of high titer. The anti double-stranded DNA (ds-DNA) antibody titers were increased in 2 patients. Three patients had positive anti-nucleosome antibody (ANuA) while the other 1 patient did not test it. The complement levels were decreased in 3 patients. The systemic lupus erythematosus disease activity index (SLEDAI) scores were more than 4 points in all the patients (ranging from 7-16), suggesting active disease. Ocular symptoms included pain, redness of the eye and tears. Ophthalmic examinations revealed 3 cases of episcleritis and 1 case of scleritis. Among the 4 patients, 2 patients expe-rienced ocular complications including decrease in vision and uveitis. All the patients were treated with systemic corticosteroids combined with hydroxycloroquine; 3 patients were treated with immunosuppres-sants (cyclophosphamide in 2 patients and leflunomide in 1 patient). All of the 4 patients received topical steroid and 1 patient received periocular injection of triamcinolone acetonide; 1 patient received topical nonsteroidal anti-inflammatory drug (NSAID).No recurrence of episcleritis or scleritis was observed during the follow-ups. As a conclusion, scleritis and episcleritis, although uncommon, may occur in patients with autoimmune rheumatic diseases including SLE. The occurrence of episcleritis and scleritis may suggest active disease of SLE. Ocular complications need to be aware of in the patients. Prompt diagnosis and treatment was associated with good visual outcomes in the follow-ups.