Eye Involvment
Systemic lupus is a chronic autoimmune disease that can affect
any part of the body, including the eyes. Lupus most often affects the heart,
joints, skin, lungs, blood vessels, kidneys and central nervous system (CNS).
The clinical course is unpredictable and is characterized by periods of
remissions and flares, which may be acute or chronic.
The effects lupus may have in and around the eyes include:
- Changes in the skin around the eyelids
- Dry eyes
- Inflammation of the white outer layer of the eyeball (scleritis)
- Blood vessel changes in the retina -- the light-sensitive lining inside the
eye - Damage to nerves in the muscles controlling eye movement and the nerves
affecting vision
- This is most often related to the discoid lupus
erythematosus form of cutaneous lupus. - The skin lesion is well-defined, slightly raised, scaly, and misformed
(atrophic). - There are typically no symptoms, but occasional burning and itching may
occur. - Scarring may result in deformities along the edge of the
eyelids.
- Approximately 20 percent of people with lupus also have
Sjögren’s syndrome, a condition in which the tear glands do not produce
sufficient tears to lubricate and nourish the eye. - Typical symptoms are irritated, gritty, scratchy, or burning eyes, a feeling
of something in the eyes, excess watering, and blurred vision. - Advanced cases of dry eyes may result in damage to the front surface of the
eye and impaired vision. - The dry eye that is seen in lupus cannot be distinguished from other dry eye
conditions.
Scleritis
- This painful red eye condition is caused by inflammation in
the white scleral (outer) layer of the eye. - Scleritis occurs in approximately one percent of people with lupus and may
be the first sign of the disease.
retina)
- This is the most common form of eye involvement in
lupus. - The occurrence in lupus can vary depending on the population studied. The
lowest incidence reported is three percent, seen in outpatient clinics, and the
highest is 28 percent in those hospitalized for lupus-related
complications. - The presence of these lesions seems to correlate with active disease.
- Retinal blood vessel changes are due to lack of adequate blood supply to
this delicate tissue, and may cause decreased vision ranging from mild to
severe. For individuals with severe retinal vascular disease, the prognosis for
vision is poor. - Retinal vein occlusions (blockages) and retinal artery occlusions have been
reported, but these complications are rare and seem to be more related with CNS
lupus. - The choroidal layer of the eye -- the nourishing tissue underneath the
retina -- can also be affected by lupus, but this is very uncommon. This
involvement can appear as excess fluid between the retinal layers. There is an
association between lupus choroidal disease and blood vessel disease in the
rest of the body, which may be related to kidney disease and blood vessel
disease complications seen in lupus.
- Cranial nerve palsies can result in double vision, poor eye
movement and alignment, poor pupil reflexes, and droopy eyelids. - Lupus optic neuropathy occurs in one-two percent of people with
lupus. Slow progressive vision loss also can result in more rapid
loss of vision from lupus optic neuropathy. - Damage to the visual nerve fibers in the brain may cause hallucination and
loss of peripheral vision and/or central vision.
lupus may have ocular side effects. For example, hydroxychloroquine
(Plaquenil®) can cause retinal toxicity if taken in large doses over
time. Regular annual comprehensive eye examinations are recommended by the
American Optometric Association for people with lupus, especially for anyone
taking Plaquenil.
This information comes from the Lupus Foundation of America.