5 Ways Lupus Affects the Eyes

Lupus is a chronic autoimmune disease that affects the skin, blood vessels, joints, heart, kidneys and nervous system. Lupus can also affect the eyes. Normally, the immune system fights off foreign invaders such as a virus or bacteria. People with lupus, however, have an immune system that functions abnormally by attacking healthy tissue. People with lupus often have times of severe flare-ups and remissions. During a flare-up, inflammation and swelling occurs in the body, creating fatigue, pain and tissue damage. The eyes are also a target of the disease. Below are five common eye problems often associated with lupus.

1
Dry Eye Disease or Keratoconjunctivitis Sicca

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Dry eyes seem to occur often with autoimmune conditions. However, people with lupus can have a dry eye condition called dry eye syndrome. Dry eye syndrome is a condition in which dry eye symptoms become quite severe, often creating a gritty, sandy sensation in the eye as well as itching and burning. Normal tear volume is significantly decreased, affecting the overall health of the external parts of the eye, such as the cornea and conjunctiva.

If dry eye syndrome occurs along with arthritis and a dry mouth sensation, the condition is called Sjogren’s Syndrome. Sjogren’s Syndrome is more common in people suffering from autoimmune arthritis conditions as well as lupus.

2
Eyelid Disease

Close-up of woman's eyes
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The eyelids can also become irritated in people who suffer from autoimmune conditions. People with lupus can develop a bothersome skin condition called discoid lupus erythematosus, which appears as a thickened rash over the eyelids. The rash is made up of scaly, disc-shaped lesions. The rash mostly appears in areas that receive sun exposure. Exposure to cigarette smoke, even second-hand smoke, may also play a role in the condition. Sometimes the condition occurs independent of lupus, but about 10 percent of people who have discoid lupus erythematosus will develop systemic lupus erythematosus. The lesions usually respond well to oral steroid treatment.

3
Retinal Disease

Examination of a patient's retinal, conjunctiva, cornea, optic nerve, blood vessels, with a slit lamp
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Retinal vasculitis is a complication of lupus in which blood supply to the retina is reduced or limited. When this occurs, the retina tries to repair itself by developing new blood vessels, a process called neovascularization. Unfortunately, these new blood vessels are fragile and weak. Blood and fluid tends to leak out of them, causing swelling in the retina. When vasculitis involves the macula, central vision can be decreased or lost. Vasculitis can also affect the optic nerve and eye muscles.

Eye doctors also may observe "cotton wool spots" in the retina. Cotton wool spots are small, whitish areas of the retina that are swollen because of lack of proper blood flow and oxygen to the area. The direct observation of cotton wool spots gives the doctor an idea of what level of disease may be going on in the rest of the body.

4
Scleral Disease

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Lupus can also cause scleritis. The sclera is the white, tough outer coating of the eyeball. Scleritis causes the sclera to become inflamed and painful. Due to the inflammation, the sclera becomes thinner, creating a very weak area of the eye that can actually perforate or increase the risk of serious damage if eye trauma were to occur in the future. For most people, scleritis mainly causes pain, light sensitivity, blurred vision, and redness or dark patches on the sclera. Scleritis can be treated with oral and topical steroids and nonsteroidal anti-inflammatory medication. If you begin to notice symptoms that suggest scleritis, contact your eye doctor immediately.

5
Nerve Disease

High eye pressure can damage the optic nerve. BSIP/UIG

Although not common, some people with lupus develop optic neuritis. Optic neuritis is an inflammation of the covering around the optic nerve. Usually only one eye is affected, but profound vision damage can occur. Optic neuritis related to lupus often causes the optic nerve to atrophy.

Optic neuropathy can also occur with lupus. Optic neuropathy occurs when the blood vessels supplying the optic nerve are blocked, causing a stroke-like condition in the eye. This is a very serious condition that requires prompt treatment. Call your eye doctor immediately if you think you may have this type of condition.

Source:

R. R. Sivaraj, O. M. Durrani, A. K. Denniston, P. I. Murray and Caroline Gordon. Ocular Manifestations of Systemic Lupus Erythematosus, pp 1757–1762.

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