Vitiligo is a long-term condition characterized by the loss of melanin, the pigment that gives color to skin, hair, and eyes. This results in the appearance of pale white patches on various parts of the body. While commonly associated with skin and hair, vitiligo can affect the eyes and the structures surrounding them. The condition occurs when the body’s immune system mistakenly attacks and destroys melanocytes, the cells responsible for producing melanin.
How Vitiligo Appears in the Eyes
Vitiligo can manifest in and around the eyes. Depigmentation of the eyelids, known as leukoderma, presents as white patches on the skin surrounding the eyes. This is a common external sign, often appearing symmetrically on both sides of the face.
Vitiligo can also cause poliosis, which is the premature whitening or graying of eyelashes and eyebrows. This occurs when melanocytes in the hair follicles stop producing pigment, leading to a noticeable change in hair color in these areas. These external changes are primarily cosmetic, though they can increase sensitivity to sunlight.
Internally, vitiligo can affect the iris, the colored part of the eye, leading to pigment loss or variations in eye color, known as heterochromia. Changes in eye color are not usually associated with significant visual impairment. Melanocytes are also present in the retinal pigment epithelium (RPE), a layer at the back of the eye that supports the light-sensitive cells of the retina.
Disruption of melanocytes in the RPE can lead to pigmentary abnormalities, such as hypopigmentation or hyperpigmentation. Despite these changes, vitiligo affecting the iris or RPE does not severely impact vision. However, vitiligo can be associated with a rare autoimmune condition called Vogt-Koyanagi-Harada (VKH) syndrome, which involves inflammation of the uvea (the middle layer of the eye) and can, in severe cases, lead to vision problems. Inflammation of the retina or iris (retinitis or iritis) can occur, though vision is often unaffected. Common ocular symptoms include sensitivity to light, redness, dry eyes, or changes in tear production.
Identifying Ocular Vitiligo
Diagnosing vitiligo affecting the eyes involves a thorough examination by a dermatologist or ophthalmologist. Diagnosis begins with a clinical examination of the external eye structures, including the eyelids, eyelashes, and eyebrows, to identify any visible signs of depigmentation or poliosis. The doctor will also inquire about the patient’s history, especially if vitiligo patches are present elsewhere on the body, as this provides important context.
A slit-lamp examination observes internal eye structures like the iris. This specialized microscope allows the ophthalmologist to look for pigment loss or inflammation within the iris. A funduscopic examination assesses the retina. This involves dilating the pupils for a clear view of the back of the eye, allowing the doctor to check for pigmentary changes in the retinal pigment epithelium.
Treatment and Management for Ocular Vitiligo
There is no cure for vitiligo, including ocular forms, but strategies can manage symptoms and improve appearance. For depigmentation of the eyelid skin, topical treatments like corticosteroids or calcineurin inhibitors may be prescribed. Topical corticosteroids can help restore some skin color, but long-term use around the delicate eye area requires careful monitoring due to potential side effects like skin thinning.
Calcineurin inhibitors (e.g., tacrolimus or pimecrolimus) are often preferred for sensitive areas like the eyelids due to a better safety profile and fewer long-term side effects compared to corticosteroids. These medications modulate the immune system to prevent melanocyte destruction and may be applied once or twice daily, showing effects within a few months. Targeted phototherapy, such as the 308-nm excimer laser, is another option for eyelid depigmentation. This laser delivers specific ultraviolet B (UVB) light directly to affected skin, potentially stimulating melanocytes without affecting surrounding healthy skin.
For depigmented eyelashes and eyebrows (poliosis), cosmetic solutions can camouflage the appearance. Specialized mascaras or dyes can color the white hairs, providing a temporary but effective solution. Microblading may also be considered for eyebrows to create the illusion of fuller, pigmented brows.
Protecting the depigmented skin around the eyes from sun exposure is important due to increased sensitivity and sunburn risk. Wearing UV-protective sunglasses and applying broad-spectrum sunscreen (SPF 30+) to the skin around the eyes are recommended. Regular eye check-ups are also advised to monitor for changes in ocular health, especially if the retinal pigment epithelium is affected, or to address associated eye conditions like uveitis.