Systemic lupus erythematosus (lupus) is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues. This inflammation can affect many parts of the body, including the eyes. Lupus can lead to various eye problems, from mild discomfort to conditions that may affect vision.
How Lupus Affects the Eyes
Lupus can impact eye health as the immune system targets and inflames various eye tissues. Dry eyes, affecting about one-third of individuals with lupus, are a common manifestation. This often results from secondary Sjögren’s syndrome, an autoimmune condition where the immune system attacks moisture-producing glands. Inflamed tear glands produce fewer tears, causing irritation, a gritty sensation, or blurred vision.
The retina, the light-sensitive tissue at the back of the eye, can also be affected by lupus retinopathy. This involves inflammation and damage to retinal blood vessels (retinal vasculitis), which can compromise blood flow and lead to vision changes or blind spots. Retinal vasculitis may appear as cotton wool spots or hemorrhages. In severe cases, blockages in retinal blood vessels (vascular occlusions) can occur, potentially causing sudden vision loss.
Lupus can also inflame or damage the optic nerve, called optic neuropathy or optic neuritis. This nerve transmits visual information from the eye to the brain. Damage can result in vision changes, pain with eye movement, or vision loss.
Lupus can also cause inflammation in the outer layers of the eye. Scleritis involves inflammation of the sclera, the white outer protective layer, leading to redness, pain, and light sensitivity. Episcleritis is a milder inflammation of the tissue covering the sclera, presenting with similar but less severe symptoms. Uveitis, an inflammation of the uvea, can also occur, potentially causing vision disturbances. This often presents as choroiditis, inflammation of the choroid that supplies blood to the retina.
Medication-Related Eye Issues
Certain medications used to treat lupus can have ocular side effects. Hydroxychloroquine, commonly known as Plaquenil, is an antimalarial drug frequently prescribed for lupus. Long-term use carries a rare but serious risk of retinal toxicity, specifically affecting the macula, the central part of the retina responsible for sharp, detailed vision. This can lead to a “bull’s-eye” maculopathy, which, if undetected, can cause irreversible vision loss. Regular ophthalmological screening is important for individuals taking this medication.
Corticosteroids are another class of medications used to manage lupus inflammation. Prolonged use can increase the risk of cataracts and glaucoma. Cataracts involve clouding of the eye’s natural lens, leading to blurred vision. Glaucoma, characterized by increased pressure inside the eye, can damage the optic nerve and result in permanent vision loss if left untreated.
Recognizing and Addressing Eye Symptoms
Individuals with lupus should be aware of various eye symptoms that could indicate ocular involvement. Persistent dry, gritty, or itchy eyes are common, as are blurred or fluctuating vision. Eye pain, redness, or increased sensitivity to light (photophobia) can also signal an issue. Less common but important symptoms include double vision, the appearance of floaters or flashes of light, changes in color perception, or any sudden vision loss, whether partial or complete.
Routine ophthalmological examinations are important for individuals with lupus, even in the absence of symptoms. These regular check-ups allow for early detection of potential eye problems, which can be crucial for preserving vision. Early intervention can significantly minimize the impact of lupus-related eye conditions.
It is important to contact a rheumatologist or an ophthalmologist immediately if any new, worsening, or severe eye symptoms appear. Prompt medical attention can help ensure timely diagnosis and appropriate management. This approach supports overall eye health and can prevent more serious complications.
Managing Lupus-Related Eye Conditions
Effective management of lupus-related eye conditions often requires close collaboration between a rheumatologist, who oversees the systemic lupus treatment, and an ophthalmologist, who specializes in eye care. This team approach ensures comprehensive care addressing both the underlying autoimmune disease and its specific ocular manifestations. Controlling systemic lupus activity with immunosuppressants or other lupus medications can often lead to improvement in eye symptoms.
Specific eye treatments are tailored to the particular condition. For dry eyes, lubricating eye drops are a common initial approach to alleviate discomfort. Anti-inflammatory eye drops or oral medications may be used to address inflammation in conditions like uveitis or scleritis. In more severe cases, such as advanced retinopathy or certain types of glaucoma, laser therapy or surgical interventions might be considered to prevent further vision loss.
Regular eye screenings remain important for individuals receiving medications with known ocular side effects, such as hydroxychloroquine or corticosteroids. These screenings help monitor for any drug-induced changes and allow for timely adjustments to treatment plans if necessary. The overarching goal of treatment is to reduce inflammation, prevent further damage to ocular structures, manage uncomfortable symptoms, and ultimately preserve vision.