Lupus and Your Eyes

Due to the systemic inflammatory process in our bodies, Lupus can affect ALL systems in our body, including our eyes.  Also, the medications that are typically prescribed can cause issues in our eyes so it’s imperative that we get our eyes checked yearly. There are 5  ways that Lupus can affect your eyes.

1.  Dry Eye Disease or Keratoconjunctivitis Sicca

Dry eyes are commonly seen in those with autoimmune conditions.  However, Lupus patients commonly develop Dry eye syndrome.  Dry eye syndrome is a condition in which dry eye symptoms become progressively worse, 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.

This is due to the dryness of the eyes.  Lupus decreases lubricants that we need to coat and protect our eyes and normal tear volume is significantly decreased, lacking the protection for our external eye parts such as our cornea and conjunctiva.

Sjogren’s Syndrome is when the dry eye syndrome occurs along with arthritis and dry mouth.  Sjogren’s Syndrome is more common in people suffering from autoimmune arthritis conditions and lupus.

2.  Eyelid Irritation

Lupus patients can have a skin condition called discoid lupus erythematosus, which appears as a thickened rash over the eyelids.  The rash is typically made up of scaly, disc-shaped lesions.  The rash mostly appears in areas that receive sun exposure. Exposure to cigarette 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.

Discoid rash commonly appears in areas that are exposed to the sun.  Research indicates that exposure to cigarette smoke may also play a role in the condition.  If you suspect you have Discoid Lupus   and have a rash over your eyelid, ask your doctor for oral steroid treatment as it tends to respond very well to it.

3.  Retinal Disease

Retinal vasculitis is a complication of lupus where supply to the retina is compromised. When this occurs, the retina tries to repair itself by developing new blood vessels, through a process called neovascularization.

Unfortunately, the new blood vessels tend to be fragile and weak and as a result, blood and fluid tend to leak out of them, resulting in swelling in the retina.

When vasculitis involves the macula, ( a region in our eye that allows us to see), 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 a small, whitish areas of our retina that become swollen due to lack of proper blood flow and oxygen to the area.  This assessment of the cotton wool spots gives the doctor an idea of the severity of disease in the rest of the body.

4.  Scleral Disease

Lupus can also cause inflammation of the sclera, 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 easily be damaged.   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.

Symptoms of scleritis is a 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.

5.  Nerve Disease

In rare cases, some Lupus patients develop optic neuritis.  Optic neuritis is an inflammation of the covering around the optic nerve. Usually, only one eye is affected, but notable vision damage can occur. Optic neuritis related to lupus often causes the optic nerve to shrink in size (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.

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