Lupus and Eye Issues: How Lupus Affects Your Eyes

Lupus is a chronic autoimmune disease that causes the immune system to attack healthy parts of the body, creating pain, inflammation and fatigue.

Eyes are among the parts of the body that lupus can affect, causing issues of dry eye, scleritis, retinal vascular lesions, blood vessel changes in the retina and sometimes nerve damage.

More than 1.5 million Americans live with lupus.

What Is Lupus?

Lupus is a complex chronic autoimmune condition that causes the immune system to react hyperactively. The immune system attacks healthy tissue and creates pain, inflammation and fatigue. It can affect the blood vessels, the heart, skin, joints, lungs and kidneys.

Lupus can also affect the eyes and their surrounding areas, leading to various vision complications.

In the United States, Lupus affects more than 1.5 million people.

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How Does Lupus Affect Your Eyes?

The human eye is a complex organ made of intricate structures that work harmoniously to allow sight. These structures include the macula, iris and cornea, all of which are interconnected by an extensive network of nerves and blood vessels.

Lupus can affect various structures in the eye, thereby affecting your vision and potentially leading to vision complications. In rare cases it can lead to blindness.

Eye Issues from Lupus

The autoimmune disease can affect the eyes in various ways. It may cause some of the following common eye complications:

• Dry eye
• Scleritis
• Retinal vascular lesions
• Nerve damage
• Discoid lesions

Dry Eye                  

Also known as keratoconjunctivitis sicca, dry eye is the most common eye complication arising from lupus. About a third of people with lupus end up developing dry eye syndrome. Dry eye is usually the result of tears drying up too quickly or being underproduced, which then affects the eyes’ ability to lubricate themselves.

Symptoms of keratoconjunctivitis sicca include:

• Blurry vision
• A burning or stinging sensation
• Feeling like your eyes have grit or sand
• Light sensitivity
• Redness

Mild dry eye syndrome can be treated with artificial teardrops. Severe cases may require immunosuppressive medication, corticosteroid eye drops, or surgical intervention.

Scleritis

This is a painful condition in which the white part of the eye — the sclera — gets inflamed. In many cases, scleritis is the first notable sign of lupus development.

Scleritis can occur in the front or back of the eye. Common scleritis symptoms include:

• Tenderness of the eyes
• Blurry vision
• Sensitivity to light
• Redness
• Pain
• Tearing

Doctors treat scleritis by managing the inflammation through oral corticosteroids, IV biologics and immunosuppressant medication.

Retinal Vascular Lesions

This is a condition where blood vessels in the retina change, and it is prevalent in about 10 percent of people who have lupus. Mild cases of the condition usually have no accompanying symptoms, although some cases may include vision distortion or loss and eye floaters.

Treating retinal vascular lesions mainly involves managing the inflammation through corticosteroids. Immunosuppressants may also be used to mitigate the condition and prevent further deterioration.

Nerve Damage

The optic nerve transfers visual data from the retina to the brain. Inflammation of the optic nerve can lead to lupus, a condition that leads to the development of optic neuritis.

Damage can result in damage to the myelin, a protective layer of the nerve. Symptoms of optic neuritis may include:

• Blurry or dim vision
• Pain when moving your eyes
• Changes in how the pupil responds to light
• Difficulty distinguishing colors

Treating nerve damage involves high-dose IV corticosteroids, which can reverse the vision loss when administered early.

Discoid Lesions

Discoid lupus is a subtype of cutaneous lupus that affects your skin. Effects of the condition are visible in parts exposed to sunlight and appear as a scaly rash.

Symptoms of discoid lesions may include:

• Conjunctivitis
• Puffy eyes
• Loss of eyebrows or lashes
• Trichiasis – irritation from abnormal eyelash positioning
• Entropion or ectropion – eyelids turning inward or outward, respectively

The treatment for discoid lesions typically involves oral hydroxychloroquine and corticosteroids. The doctor may also advise you to avoid sunlight to lessen the effects of the condition.

Side Effects of Lupus Medication

As established above, lupus can lead to numerous health complications. As a result, doctors turn to multiple medications to treat various complications.

Each medication has its known side effects, and it is prudent to discuss with your doctor the possible side effects and what to do if you experience any of them.

Hydroxychloroquine

Hydroxychloroquine is one of the most used prescription medications against lupus. Possible side effects may include stomach pain, diarrhea, nausea, and other digestive problems.

Steroids

Steroids are another common remedy used to treat lupus. Common steroid side effects include weight gain, swelling, and insomnia.

NSAIDs

Non-steroidal anti-inflammatories (NSAIDs) can help reduce inflammation and pain in lupus patients. Possible NSAIDs side effects include ulcers, stomach pain, and general digestive complications.

Immunosuppressives 

Immunosuppressives can also be used to prevent your immune system from attacking healthy tissue. Possible immunosuppressive complications include damage to various organs and a risk of cancer development.

Recognizing Symptoms

It is important to constantly monitor your eye health and keep a lookout for common lupus symptoms. While the symptoms can range widely, some of the most common and easy to recognize warning signs include:

• Dry eyes
• Redness
• Eyelid rashes
• Eye inflammation
• Constantly experiencing eye infections like conjunctivitis

Diagnosing Lupus-Related Eye Conditions

Doctors diagnose lupus by reviewing your medical history and conducting series of blood tests. Eye problems may be taken into account when diagnosing the condition.

Various eye exams can help in the diagnosis of the autoimmune condition. If you are diagnosed with lupus, it’s important to have your eye health and overall health monitored as well.

Lupus FAQs

How does lupus affect your eyes?

Lupus can affect the eyes in various ways. Lupus patients often experience eyesight changes that may include inflammation, blood vessel changes in the retina, dry eyes and general pain.

Can an eye exam detect lupus?

Certain eye tests and examinations can play a crucial role in identifying lupus, especially in the early stages. Regular comprehensive ocular tests are not only a great way to monitor your eye health but also detect lupus development.

How is lupus of the eye treated?

Since lupus can affect the eyes in various ways, the treatment approaches may vary. Treating ocular lupus may involve different medications, including immunosuppressants, artificial tears and corticosteroids.

References

1. Epidemiology of Systemic Lupus Erythematosus: An Update. (March 2018) National Center for Biotechnology Information.

2. The Complexity and Origins of the Human Eye: A Brief Study on the Anatomy, Physiology, and Origin of the Eye. (April 2010). Liberty University.

3. Prevalence of Dry Eye in Patients with Systemic Lupus Erythematosus: A Meta-analysis. (April 2020) British Medical Journal.

4. Ocular Manifestations of Autoimmune Disease. (September 2002). American Academy of Family Physicians.

5. Bilateral Retinal Vasculitis as the First Presentation of Systemic Lupus Erythematosus. (May 2021) American Journal of Case Reports.