Systemic lupus erythematosus is a chronic autoimmune disorder that occurs predominantly in young women. SLE causes inflammation and damage in different areas of the body and is a disease of flare-ups and remissions. Treatment typically involves corticosteroids, immunosuppressant medications and an antimalarial medication. One of the commonly affected organs is the eye, as the inflammation of lupus can affect almost all areas of the eye.
Eyelid Disease
Systemic lupus erythematosus can cause a rash on the eyelids. This rash is called a discoid rash and consists of raised scaly patches. Treatment with systemic anti-inflammatory medications can often offer relief for this type of lupus eye disease.
Dry Eye Syndrome
In an article in the journal "Rheumatology" published in 2007, R.R. Sivaraj and colleagues state that dry eye syndrome occurs in approximately one-third of all patients with lupus. The cause of dry eye is inflammation in the lacrimal gland that produces tears. Dry eye can range from mild to severe in these patients. Treatment includes artificial tear drops and, if needed, a temporary or permanent blockage, or occlusion, of the tear drainage channels in the eye.
Corneal Disease
In systemic lupus erythematosus, the cornea can also have recurrent epithelial cell breakdowns, which can cause pain and tearing that may improve over the course of the day. There can also be peripheral ulcerations on the cornea that can be indicative of vasculitis, or active inflammation in the blood vessels. These conditions can occur in addition to any changes that may happen in the cornea associated with dry eye syndrome.
Episcleral/Scleral Disease
Inflammation of the episcleral and scleral tissues can be one of the first signs of lupus. These are superficial--episcleritis--and deeper--scleritis--inflammatory conditions that have differing levels of severity. Episcleritis is mild and typically self-limiting. Scleritis, on the other hand, is extremely painful and can lead to vision loss. Scleritis may be associated with retinal detachments and swelling and should be evaluated by an ophthalmologist immediately. Scleritis is a sign of systemic inflammatory activity and requires systemic treatment.
Retinal Disease
The retina can be affected in 10 percent of lupus patients, according to Dr. Sivaraj. The lupus retinopathy can cause visual field loss or decreased visual acuity; the inflammation of the vessels in the retina leave changes similar to those seen in hypertensive or diabetic retinopathy. In the more severe cases, lupus retinopathy can lead to retinal detachment and vitreous hemorrhage, or bleeding in the eye. Retinal and arterial vessel occlusion can occur in rare cases. Systemic immunosuppression is important in treatment, but ophthalmologists may need to address specific issues in the retina with surgical procedures, such as laser therapy.
Choroidal Disease
The choroid, which is the layer of blood vessels below the retina, can also be affected in lupus. This can cause significant visual loss as well. In SLE eye disease, the inflammation in this layer can cause leakage and lead to retinal detachments. It is difficult to evaluate these changes on a dilated eye examination; typically, a dye test with photographs of the back of the eye would be needed to accurately diagnose these changes.
Nerve Disease
Optic neuritis is often associated with multiple sclerosis; however, it has been seen in systemic lupus erythematosus as well. The lupus eye disease optic neuritis is an inflammation of the covering around the optic nerve and presents with loss of vision in one eye. Unlike in other diseases, optic neuritis in SLE tends to progress and can lead to optic atrophy. Another condition, optic neuropathy, can occur when the blood vessels supplying the optic nerve are blocked. The prognosis is poor, but systemic immunosuppressant therapy may be of benefit.
References
- The Lupus Site: Mouth, Nose and Eyes
- Lupus Foundation of America: The Eyes
- "Eye Manifestations of Lupus And Sjogren’s Syndrome"; Kevin Wade, MD; 2005
- "Rheumatology"; Ocular Manifestations of Systemic Lupus Erythematosus; R. R. Sivaraj, O. M. Durrani, A. K. Denniston, P. I. Murray and Caroline Gordon; 2007
