Lupus and vision problems: Common conditions and treatments - Medical News Today

Lupus is a chronic autoimmune condition in which the immune system becomes overactive and attacks healthy tissue. It most often affects the heart, joints, skin, lungs, blood vessels, kidneys, and central nervous system. Lupus can also result in damage to the eyes and the area around them, which may cause vision problems.

Lupus is a complex autoimmune condition that affects about 1.5 million people in the United States. Although lupus most commonly affects the skin, joints, and internal organs, it can affect many parts of the body, including the eyes. Some people may even refer to lupus as "the disease with 1,000 faces," as it can produce a wide variety of symptoms.

Lupus can affect anyone, but some people have a higher risk of developing the condition. Evidence notes that females aged 15–44 years, people belonging to certain racial groups, and those with a family history of autoimmune disease are at the highest risk. There are four main types:

• Systemic lupus erythematosus (SLE): This is the most common type of lupus, and it affects all parts of the body.
• Cutaneous lupus erythematosus: This type of lupus only affects the skin.
• Drug-induced lupus: This short-term type of lupus results from certain prescription drugs.
• Neonatal lupus: Neonatal lupus is a rare type of lupus that affects newborn babies.

In this article, we discuss how lupus may affect the vision and which eye conditions are associated with lupus.

The human eye is an intricate organ comprising many different structures, such as the cornea, iris, and macula, which work together to allow sight. It features many blood vessels and optic nerves that are necessary for correct functioning. Lupus can damage the structures of the eye and cause inflammation of both blood vessels and nerves, which can result in a loss of vision.

Below, we outline some common eye conditions associated with lupus.

Dry eye, also known as keratoconjunctivitis sicca, is one of the most common eye complications of lupus. Evidence suggests that roughly one-third of people with SLE may experience dry eye syndrome.

Dry eye symptoms can occur for multiple reasons, but they usually result from the tear ducts not producing enough tears or the tears drying up too quickly without adequately lubricating the eye. These effects may be due to inflammation of the lacrimal glands affecting tear production or inflammation of the eye and eyelids preventing a person from blinking properly to stimulate tear production.

Many people with lupus may also have Sjögren's disease, an autoimmune condition that can affect the lacrimal glands. Evidence suggests that 14–18% of people with SLE also have Sjögren's.

The symptoms of dry eye can include:

• a scratchy feeling in the eye, as though it has sandy or grit in it
• a stinging or burning sensation
• redness
• blurry vision
• sensitivity to light

Doctors may treat mild cases with over-the-counter artificial tear eye drops. For more severe or chronic cases, they may suggest immunosuppressive medication, such as cyclosporine (Restasis), or corticosteroid eye drops to treat the inflammation. In cases where medication does not bring relief, treatment may involve surgical implants that plug the tear ducts and stop the eyes from draining, allowing them to stay hydrated longer.

Scleritis is the term for inflammation of the sclera, which is the white part of the eye. Evidence suggests that this painful condition occurs in 1% of those with SLE and that it may even be the first symptom of this disease in some cases. There are two main types of scleritis: anterior scleritis, which occurs at the front of the eye, and posterior uveitis, which occurs at the back.

The symptoms of scleritis may include:

• pain
• redness
• tenderness of the eye
• blurry vision
• tearing
• light sensitivity

The treatment options for scleritis focus on managing the inflammation — either eye inflammation, specifically, or general inflammation from lupus — and minimizing pain and discomfort. They include oral corticosteroids, immunosuppressant medications, and IV biologics that aim to target inflammatory pathways.

This refers to blood vessel changes in the retina, which is the light-sensitive layer of tissue in the back of the eye. Evidence notes that 10% of people with lupus may experience retina involvement, with retinal vasculitis — the inflammation of retinal blood vessels — being one of the more common types. Evidence suggests that retinal involvement may indicate that lupus is generally active in the body.

Mild cases of retinal involvement may have no symptoms. However, in other cases, the symptoms may include loss or distortion of vision and floaters in the eye. The extent of vision loss can vary depending on the severity of the retinal damage.

Lupus can cause lesions in the retina that may appear as either small hemorrhages or fluffy, white patches known as cotton wool spots. In other cases, blockages in the retina, known as vaso-occlusive retinopathy, may occur and affect a person's vision.

The treatment for retinal symptoms usually involves managing the systemic inflammation with corticosteroids and then using immunosuppressants to prevent further flare-ups.

Lupus may affect a person's eyes due to inflammation of the optic nerve, known as optic neuritis. The optic nerve is responsible for transferring visual information from the retina to the brain. Although inflammation of the nervous system can occur due to SLE, only 1% of people with this condition experience optic nerve involvement.

Inflammation of the optic nerve can result in damage to the protective layer of the nerve, known as myelin. This damage can prevent signals from sending properly, leading to visual symptoms. The blood vessels that supply the optic nerve are also susceptible to damage. Without sufficient blood flow, the optic nerve may not function properly, leading to vision loss.

The symptoms of optic neuritis can include:

• pain when moving the eye
• difficulty distinguishing between colors
• changes in the pupil's response to bright light
• dim or blurry vision

If treatment occurs promptly, it is possible to reverse vision loss resulting from optic nerve inflammation and damage. Treatment typically aims to reduce the systemic inflammation with the use of high dose IV corticosteroids and then a lower dosage of oral corticosteroids.

Discoid lupus is a form of cutaneous lupus that affects the skin. It typically appears as a scaly rash on areas of the body that receive exposure to sunlight. Approximately 5–6% of people with discoid lupus may experience these skin symptoms on their eyelids.

The inflammation and potential scarring can irritate a person's eye and cause symptoms such as:

• puffy eyes
• trichiasis, which is irritation due to the abnormal positioning of eyelashes
• loss of eyelashes or eyebrows
• conjunctivitis
• the eyelid turning inward or outward, known as entropion and ectropion, respectively

The treatment options for discoid lesions on the eyelids include oral hydroxychloroquine and topical treatment of the eyelids using corticosteroids. A doctor may also recommend avoiding sunlight when recovering, as this can worsen the symptoms.

Eye involvement in lupus can be a complex issue. A person may need to visit an eye doctor, who can determine the exact cause.

If a person with lupus is experiencing vision disturbances or discomfort in their eyes, they may wish to consider contacting their doctor. Eye symptoms from lupus can manifest in many ways and may become more severe without treatment.

Lupus can affect any part of the body, including the eyes. Systemic inflammation can affect the blood vessels and nerves in the eyes, as well as the surrounding skin.

In some cases, eye involvement is mild, and many conservative treatment options are available. However, in other cases, eye involvement can be sight threatening and may need more aggressive treatment. Typically, treating the underlying lupus inflammation is effective in relieving eye symptoms and preventing ongoing damage.