Lupus, or systemic lupus erythematosus (SLE), is a chronic autoimmune disease where the body’s immune system mistakenly attacks healthy tissues and organs. This systemic condition causes inflammation and damage in various parts of the body, including joints, skin, blood, and internal organs. Symptoms can fluctuate, with periods of active disease (flares) and remission. This disorder affects approximately 1.5 million people in the United States, with symptoms varying significantly among individuals.
How Lupus Can Affect the Eyes
Lupus can affect the eyes, impacting vision through several mechanisms. The immune system’s misdirected attack leads to inflammation of blood vessels and tissues within the eye. This inflammation can directly damage eye structures or indirectly cause problems by compromising blood flow. Eye problems may coincide with lupus flares, or even appear before other systemic lupus symptoms, making early detection important.
The eyes are intricate organs with delicate structures like the retina, optic nerve, and tear glands, all supported by blood vessels. Lupus-related inflammation can disrupt this balance, leading to various ocular complications. Medications used to treat lupus can also have side effects that impact eye health. Understanding the potential for eye involvement is important for managing lupus.
Specific Eye Conditions in Lupus
Dry eye syndrome, affecting up to one-third of individuals with lupus, is one of the most common eye issues. This condition occurs when the immune system attacks the lacrimal glands, which are responsible for producing tears, leading to insufficient tear production or tears that evaporate too quickly. Dry eye can cause a gritty sensation, burning, redness, blurry vision, and light sensitivity. It is often linked to secondary Sjögren’s syndrome, another autoimmune condition that frequently co-occurs with lupus and primarily targets moisture-producing glands.
Lupus can also lead to retinal vasculitis, an inflammation of the blood vessels supplying the retina, the light-sensing tissue at the back of the eye. This limits blood flow to the retina, potentially causing changes like retinal hemorrhages, cotton wool spots, or blockages, and may result in blurred vision, floaters, or vision distortion. Retinal involvement is estimated to occur in about 10% of people with lupus and can sometimes indicate active systemic disease. Optic neuropathy involves inflammation or damage to the optic nerve that transmits visual information from the eye to the brain. This can lead to sudden vision changes, including vision loss, pain with eye movement, and altered color perception, though it is a rare manifestation, affecting about 1% of lupus patients.
Inflammation can also affect the outer layers of the eye. Episcleritis is a superficial inflammation of the episclera, the tissue between the conjunctiva and the white part of the eye, presenting with redness, mild discomfort, and tearing. While often self-limiting, it can be associated with systemic inflammatory conditions like lupus. Scleritis, a more severe condition, is inflammation of the sclera, the tough, white outer layer of the eyeball. Scleritis typically causes intense eye pain, tenderness, significant redness, and may lead to blurred vision and light sensitivity.
Less common, but still possible, is choroiditis, inflammation of the choroid, the vascular layer that supplies blood to the retina. This can disrupt blood vessels and, in rare cases, lead to retinal detachment.
Recognizing Eye Symptoms and When to See a Doctor
Recognizing eye symptoms is important for managing lupus. Common signs that may indicate lupus-related eye involvement include persistent dry or gritty sensations, redness, and a burning feeling in the eyes. Individuals might also experience blurred vision, sensitivity to light, or the appearance of floaters, which are dark specks or strings that drift across the field of vision. Pain in the eye or around the eye socket, especially when moving the eyes, can also be a symptom.
Prompt medical attention from an ophthalmologist is important if new or worsening eye symptoms occur. Regular comprehensive eye examinations are recommended for individuals with lupus, typically on an annual basis. These routine check-ups can help detect eye problems early, often before symptoms become noticeable, making them easier to treat. It is also important to inform your rheumatologist about any eye symptoms, as eye involvement can sometimes signal active lupus disease elsewhere in the body.
Treatment and Monitoring for Eye Complications
Managing lupus-associated eye conditions requires a collaborative approach involving rheumatologists and ophthalmologists. Treatment aims to control underlying lupus activity and address specific ocular manifestations. Systemic medications, such as corticosteroids and immunosuppressants, reduce inflammation throughout the body, including the eyes. These medications suppress the immune system’s overactivity and prevent further damage.
For dry eyes, artificial tears are a common initial treatment. In more severe cases, prescription eye drops or other therapies may be necessary. For inflammatory conditions like retinal vasculitis, scleritis, or optic neuropathy, systemic corticosteroids are often the first line to reduce acute inflammation, sometimes followed by immunosuppressants for long-term management.
Regular monitoring through specialized eye exams tracks disease progression and assesses treatment effectiveness. This ongoing assessment helps adjust therapies to protect vision and maintain eye health.