Can Lupus Cause Glaucoma? How the Conditions Are Linked

Systemic Lupus Erythematosus (SLE), or lupus, is a chronic autoimmune disease where the immune system mistakenly attacks healthy tissues throughout the body, affecting various organs like the skin, joints, and kidneys. Glaucoma refers to eye conditions that damage the optic nerve, often due to high pressure inside the eye, leading to irreversible vision loss if untreated. This article explores how lupus or its treatments can influence glaucoma risk.

Understanding the Lupus-Glaucoma Link

Lupus does not directly cause primary open-angle glaucoma, the most common form. Instead, lupus can increase the risk of secondary glaucoma through chronic inflammation, certain medications, and related systemic conditions. Lupus-related chronic inflammation can affect eye structures like the uvea (uveitis), sclera (scleritis), or episclera (episcleritis). This inflammation can disrupt the eye’s fluid drainage system, leading to increased intraocular pressure and subsequent glaucoma.

A significant indirect link involves corticosteroids, frequently prescribed for lupus inflammation. Long-term systemic corticosteroid therapy, such as prednisone, is a known risk factor for steroid-induced glaucoma. These medications can impair the outflow of aqueous humor, leading to a buildup of pressure. This increase in eye pressure can occur within weeks to months of starting treatment, and while it often resolves after discontinuing the medication, it can cause optic nerve damage if not monitored.

Some individuals with lupus also have antiphospholipid syndrome (APS), which can lead to increased blood clot formation. These clots might affect the blood supply to the optic nerve, potentially contributing to optic neuropathy or secondary glaucoma. Additionally, lupus vasculitis, involving inflammation of blood vessels, can affect ocular blood vessels. This can compromise blood flow to eye tissues, including the optic nerve, potentially elevating the risk of glaucoma or other vision-threatening complications like neovascular glaucoma.

Recognizing Glaucoma Signs

Glaucoma often progresses without noticeable symptoms in its early stages, especially common types like primary open-angle glaucoma. Often called the “silent thief of sight,” vision loss occurs gradually and painlessly. Many people do not become aware of vision changes until significant damage has already occurred, often affecting peripheral (side) vision first.

As glaucoma advances, individuals may begin to experience a gradual loss of peripheral vision, sometimes described as “tunnel vision.” Other symptoms include blurred vision, seeing rainbow-colored halos around lights, or eye redness. Acute forms, such as acute angle-closure glaucoma, can cause rapid symptoms like severe eye pain, headaches, nausea, and vomiting. For individuals with lupus, who already face an increased risk, it is particularly important not to wait for symptoms to appear before seeking eye care.

Managing Eye Health with Lupus

Proactive eye health management is important for individuals with lupus, given their increased glaucoma risk. Comprehensive, regular eye examinations are recommended, particularly for those on long-term corticosteroid therapy. An ophthalmologist may suggest annual eye exams or more frequent check-ups depending on individual risk factors and medication use.

During an eye examination, glaucoma is diagnosed through several tests, including measuring intraocular pressure, examining the optic nerve for damage, assessing the visual field, and evaluating the eye’s drainage angle. Optical coherence tomography (OCT) also provides detailed images of the optic nerve and retinal nerve fiber layer. The primary goal of glaucoma treatment is to lower intraocular pressure to prevent further optic nerve damage, as vision loss from glaucoma cannot be reversed. Treatment options include prescription eye drops, laser therapy, or surgical procedures.

Effective eye health management for lupus patients requires a collaborative approach between their rheumatologist, who manages the systemic disease, and their ophthalmologist, who monitors eye health. This coordinated care ensures optimized treatment plans, considering potential medication side effects and disease activity. Patients should promptly report any changes in vision or eye discomfort to their doctors for early detection and intervention.