One third of lupus patients have eye symptoms, but these are not as widely publicized as the effects on the skin, nervous system, and kidneys. Medications used to treat lupus can have side effects involving the eye, but the disease itself can cause much more damage to the visual system. Monitoring eye health in lupus is important for two reasons: (1) lupus ocular complications are potentially blinding, and (2) eye symptoms are an indication of less obvious disease activity, such as kidney damage, that tends to occur in cycles of exacerbation and remission. Thus eye health can be useful in adjusting the dosage of medication to optimize the balance between its risks and benefits.
Lupus can damage almost any part of the eye. The mechanisms include immune complex deposition, inflammation of the blood vessels, blood clots, and antibody dependent cytotoxicity.
External eye disease. Discoid lupus-type rash may develop over the eyelids. The lacrimal (tear) gland can be damaged by antibody dependent mechanisms, causing dry eye from secondary Sjogren's syndrome. In less common cases, the space around the eye (the orbit) can be damaged by orbital masses, fluid accumulation, or inflammation.
Anterior segment disease. The cornea can be damaged by recurrent corneal erosions, inflammation, and loss of epithelial tissue. The sclera, or white of the eye, can become inflammed enough to cause severe pain. In less common cases, conjunctivitis (pink eye) may be caused by lupus. Pain is generally a symptom of disease of the front part of the eye (anterior segment), while visual loss generally indicates problems with the back part of the eye (posterior segment).
Posterior segment disease. Both the retina and choroid can be damaged, leading to loss of vision.
Neuro-ophthalmic disease. Both the optic nerve and the nerves that control eye motion can be affected. Abnormalities of the pupil also indicate lupus disease activity.
Ophthalmic disease as a side effect of treatment. Corticosteroids are commonly used to treat lupus. They are highly effective, but may cause cataracts and glaucoma.
The references recommend that an opthalmologist should be part of the medical team treating lupus.
Sivaraj RR et al, “Ocular manifestations of systemic lupus erythematosus”, Rheumatology 2007; 46: 1757-62.
Corticosteroids for Lupus: Balancing Risks and Benefits:
Sasha Bernatsky, MD, and Jean-Luc Senecal, MD, editors, “Lupus: Everything You Need to Know”, Firefly Books, 2005.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.