Systemic lupus erythematosus, or lupus, is a chronic autoimmune disease in which the immune system mistakenly attacks healthy tissues. It can affect various organs and systems, including joints, skin, kidneys, heart, lungs, and brain. Lupus can impact the eyes, leading to complications affecting vision and overall eye health.
Specific Ocular Manifestations
Lupus affects the eyes in various ways, with dry eye syndrome common. Often, this results from secondary Sjögren’s syndrome, reducing tear production, causing persistent dryness, irritation, and a gritty sensation. About 20-30% of lupus patients experience dry eye symptoms.
The retina, the eye’s light-sensitive tissue, is another affected area. Retinal vasculitis, an inflammation of retinal blood vessels, can occur, causing blockages and bleeding. This causes visual disturbances, including blurred vision or blind spots.
Other retinal changes include microaneurysms (tiny bulges in vessel walls) and cotton wool spots (white patches on the retina from nerve fiber damage). These often result from poor retinal blood flow and impair visual acuity.
Lupus can also affect the optic nerve, which transmits visual information to the brain. Optic neuropathy involves inflammation or damage to this nerve, causing sudden vision loss or impaired color vision. Prompt medical attention is required to prevent permanent damage.
Inflammation can extend to the outer layers of the eye, causing conditions like scleritis and episcleritis. Scleritis is a painful inflammation of the sclera, the eye’s white outer protective layer, causing severe redness and tenderness. Episcleritis involves the thinner, superficial layer covering the sclera and presents with less severe pain and redness.
The eyelids can also show signs of lupus activity, sometimes presenting with characteristic skin changes or lesions, such as discoid lupus erythematosus. These cause itching, redness, or scarring around the eyes. Long-term use of corticosteroids, a common treatment for lupus, may lead to complications like cataracts and glaucoma.
Identifying Potential Eye Symptoms
Individuals with lupus should recognize potential eye symptoms. Many experience persistent dryness, a gritty feeling, or a foreign body sensation that can be constant or worsen throughout the day. Redness and irritation are common indicators.
Pain or discomfort around the eyes can signal inflammation or pressure changes. Visual disturbances like blurred or fluctuating vision occur, varying in intensity. Sudden vision loss or blind spots are serious symptoms requiring immediate medical evaluation.
Increased sensitivity to light (photophobia) can make bright environments uncomfortable. Floaters (small specks or strands) or flashes of light can suggest retinal involvement. Double vision (where a single object appears as two) might occur, indicating issues with eye muscle control or nerve function.
Diagnosis and Management of Ocular Lupus
Diagnosing eye involvement in lupus begins with a comprehensive eye examination by an ophthalmologist. This includes assessing visual acuity, checking eye pressure, and a slit-lamp examination to view the eye’s front and internal structures. Fundoscopy, examining the retina and optic nerve, is standard.
Specialized tests like fluorescein angiography evaluate retinal blood vessels by injecting a dye and taking photographs. This identifies areas of leakage or blockage. Optical coherence tomography (OCT) provides detailed cross-sectional retinal images, allowing detection of subtle changes.
Management of ocular lupus involves a collaborative approach between the patient’s rheumatologist and an ophthalmologist. Treatment aims to control underlying autoimmune activity and address specific eye conditions. This may include systemic medications like corticosteroids or immunosuppressants to reduce inflammation.
For localized eye symptoms, treatments like artificial tears for dry eyes, anti-inflammatory eye drops, or medications to lower intraocular pressure for glaucoma may be prescribed. Regular eye check-ups monitor eye involvement progression and allow for treatment adjustments. Early detection and timely intervention preserve vision and prevent permanent damage from lupus-related eye complications.