Lupus is a chronic (lifetime) autoimmune disease that impacts various parts of the body, including the eyes. For the 1.5 million Americans and at least 5 million individuals worldwide living with this illness, understanding how lupus affects eye health can help them recognize the signs of eye problems, as well as receive immediate diagnosis and treatment to prevent complications.
Overview of Lupus
Lupus, otherwise known as systemic lupus erythematosus (SLE), is a fairly uncommon disorder in which the body’s own immune system attacks healthy tissues. It can affect the joints, kidneys, skin, brain, and other organs.
Lupus has several types, including discoid lupus erythematosus, neonatal lupus, and drug-induced lupus, but SLE is the most common and severe form. The exact cause remains unknown, and researchers are on an ongoing mission to identify what triggers the disease.
The many symptoms of lupus vary widely but often include fatigue, muscle and joint pain, skin rashes, low fevers, and swelling in the hands or feet. Lupus affects everyone differently. It ranges from mild to deadly, and periods of flares and remission often mark its progression.
How Lupus Affects the Eyes
The delicate eyes are not safe from the systemic effects of lupus. Autoimmune responses and inflammation can lead to various eye conditions, some of which can threaten vision in the absence of early detection and medical intervention.
Common Eye Conditions Associated with Lupus
According to the National Eye Institute and the American Academy of Ophthalmology, eye diseases are more common in women than men, especially with age, and this information holds true for people with lupus. But regardless of gender or age, anyone with lupus must watch out for the following:
Dry Eye Syndrome
Dry eye is one of the most commonly occurring ocular conditions in the world, especially among lupus patients. It refers to eyes that do not produce sufficient tears, or the tears evaporate too fast, leading to uncomfortable dryness. Symptoms include a gritty sensation, a burning sensation, redness, and blurred vision.
In lupus, dry eyes can result from inflammation affecting the tear glands. Treatment may involve artificial tears, anti-inflammatory medications, and punctal plugs to retain moisture.
Lupus Retinopathy
Lupus retinopathy involves damage to the retina, the light-sensitive layer at the back of the eye. Inflammation and vascular changes due to lupus are the primary causes.
Symptoms of lupus retinopathy can range from changes to peripheral vision and/or decreased visual acuity. Diagnosis requires a thorough eye exam, including retinal imaging techniques like fluorescein angiography. Treatment focuses on controlling lupus activity with systemic medications such as corticosteroids and immunosuppressants. Unfortunately, vision recovery is rare in patients with severe ocular manifestations.
Other Ways the Lupus Affects the Retina
According to the Lupus Foundation of America, changes to the retina’s blood vessels are one the most common forms of eye problems in lupus patients. These changes include:
- Retinal hemorrhages (bleeding)
- Vascular tortuosity (irregular curvature of blood vessels)
- Cotton wool spots (irregular spots visible in an eye exam)
Other signs and symptoms:
- Retinal occlusion (blood vessel blockage)
- Retinal vasculitis (inflammation of blood vessels)
- Retinal hard exudates (buildup of fats and proteins)
Optic Neuritis
Optic neuritis appears as inflammation in the optic nerve, the relatively fragile and unprotected part of the eye responsible for moving visual information from the eyeball to the brain. In lupus patients, optic neuritis can cause pain with eye movement, sudden vision loss, and color vision deficiencies. Eye doctors diagnose this condition through a combination of vision tests, MRI scans, and sometimes lumbar puncture to assess spinal fluid. Treatment often involves high-dose corticosteroids to reduce inflammation and preserve vision.
Scleritis and Episcleritis
Scleritis describes inflammation of the sclera, the white outer coating of the eye, while episcleritis is a milder inflammation of the episclera, the thin layer covering the sclera.
Scleritis manifests as severe eye pain, redness, and sometimes blurred vision, while episcleritis presents with milder pain and redness. Both conditions can be associated with lupus and require medical evaluation. Treatment may include corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or immunosuppressive medications, depending on the severity.
Uveitis
Uveitis is inflammation of the uvea, the eye’s middle layer encompassing the iris, ciliary body, and choroid. It can cause redness, pain, light sensitivity, and blurry vision.
In lupus, uveitis can be a result of systemic inflammation. Diagnosis involves a comprehensive eye check, and treatment typically includes corticosteroids and immunosuppressive agents to control inflammation.
Diagnosis and Monitoring
Regular eye exams are necessary to monitor potential eye and vision problems in lupus patients. Early detection, treatment, and management can prevent the worst, including vision loss.
The best ophthalmologists in Sun City, Arizona, use various diagnostic procedures to detect eye health concerns in those living with lupus. They include but are not limited to:
- Visual acuity test: Helps measure how well a patient sees at different distances.
- Dilated eye exam: Allows an eye care provider to examine the retina and optic nerve.
- Fluorescein angiography: Entails injecting a dye into the bloodstream to highlight blood vessels in the retina.
- Optical Coherence Tomography (OCT): Provides detailed images of the retina’s layers.
- MRI and CT Scans: Used to evaluate optic neuritis and other deep-seated ocular conditions.
Treatment and Management for Eye Diseases in Lupus Patients
Managing eye conditions associated with lupus involves a multidisciplinary approach, including ongoing appointments with rheumatologists, ophthalmologists, and other healthcare professionals depending on specific symptoms. In general, treatment and management involve:
- Medications: Systemic medications, such as corticosteroids and immunosuppressants, are commonly used to control inflammation and reduce lupus activity. Eye-specific treatments might include artificial tears for dry eyes, antibiotic or antiviral medications for infections, and intraocular injections for severe inflammation.
- Lifestyle modifications: Embracing a healthy lifestyle can help manage lupus symptoms and protect eye health. Changes include a balanced diet rich in anti-inflammatory foods, regular exercise, adequate sleep, reduced blue and ultraviolet (UV) light exposure, and stress management techniques. Related: Why Stress Is Bad for Your Eyes.
- Eye-focused protection: Shielding the eyes from ultraviolet light by wearing sunglasses, avoiding smoking, and maintaining proper hydration are extremely important for healthy vision, especially for people with lupus. Also, using a humidifier to keep indoor air moist can help alleviate dry eye symptoms.
- Professional guidance: Regular consultations with rheumatologists, ophthalmologists, and other specialists ensure comprehensive care. These medical professionals can work together to tailor treatments and monitor for any changes in condition.
Can Medications for Lupus Affect the Eyes?
Some medications prescribed to manage lupus can impact eye health. For example, high doses of hydroxychloroquine (Plaquenil), which helps manage arthritic swelling and pain, can lead to retinal toxicity. Steroids and other immunosuppressants also have side effects on the eyes.
If lupus affects your eyes, it doesn’t mean accepting the possibility of vision loss. Collaborating with top eye doctors in Phoenix, AZ, can help monitor side effects from lupus medications and maintain the delicate balance needed for suboptimal vision. If you need an ophthalmologist who can provide the eye care you deserve, our Arizona Retinal Specialists are here for you. Give us a call at 623-474-3937 to schedule your eye exam. We will do everything we can to preserve your eyesight.
