Lupus is an autoimmune disease, affecting the blood vessels, skin, heart, joints, nervous system, kidneys, and yes- even the eyes. Your immune system is set up to fight off foreign invaders such as bacteria and viruses. However, individuals who have lupus actually have immune system that functions quite abnormally.
The immune system of an individual with lupus actually attacks the healthy tissue- it can no longer tell the difference between healthy tissue and foreign invaders. Individuals with lupus are subject to flare ups as well as times of remission. When an individual is experiencing a flare up, they will have pain, inflammation and swelling in their body, which leads to fatigue and ultimately tissue damage. Following are several common eye issues that are commonly associated with lupus.
Eye Problems Associated with Lupus
Individuals with lupus can have a skin condition that is called discoid lupus erythematosus. This appears as a thickened rash over the eyelids of the individual. The rash appears to be made up of disc-shaped lesions that are scaly to the touch. This rash typically appears in areas that have been exposed to the sun. Also, being exposed to cigarette smoke could play a role in this eyelid disease. The condition can occur independent of lupus. However, approximately ten percent of individuals who have discoid lupus erythematosus will at some point develop systemic lupus erythematosus. Oral steroid treatment is usually the treatment of choice for these lesions.
Keratoconjunctivitis Sicca, or Dry Eye Disease
Dry eyes are a very common sign and symptom of an autoimmune condition. However, those individuals who have been diagnosed with lupus will experience a dry eye condition referred to as Dry Eye Syndrome. This is a condition in which the symptoms of dry eye actually become very severe. The individual will often experience a gritty, sandy sensation in their eyes as well as the normal itching and burning. They experience a significant decrease in normal tear production, which ends up affecting the overall health of the external parts of the eye, such as the conjunctiva and the cornea.
If the dry eye syndrome is occurring along with dry mouth and arthritis, it is referred to as Sjogren’s Syndrome. This syndrome is much more common in individuals who are suffering from lupus and autoimmune arthritis conditions.
A complication of lupus where the blood supply to the retina is limited or reduced is referred to as retinal vasculitis. When an individual has retinal vasculitis, the retina works to repair itself by creating new blood vessels, in a process that is called neovascularization. Unfortunately, the new blood vessels are very weak and fragile, meaning that blood and other fluids leak from them, which leads to swelling in the retina. If the vasculitis involves the macula, the individual’s central vision can be decreased, or ultimately lost. Additionally, vasculitis can affect the eye muscles and the optic nerve.
Eye physicians may observe what are called “cotton wool spots” on the retina. These are small, white areas of the retina that are swollen due to lack of proper oxygen and blood flow to the area. Directly observing these “cotton wool spots” gives the physician a better idea as to what level of the condition is going on in the rest of the body.
Another eye condition that can be caused by lupus is called scleritis. If you don’t already know, the sclera is the tough, white, outer coating of your eyeball. Scleritis causes your sclera to become painful and inflamed. Because of this inflammation, the sclera will become much thinner, which creates a weak area of the eye that can tear, or at the very least, increase the risk of serious damage being done if trauma to the eye occurs in the future. For most individuals, scleritis causes pain in the eye, sensitivity to light, blurry vision, and dark or red patches on the sclera. This condition can be treated using oral and/or topical steroids, as well as non-steroidal anti-inflammatory drugs.
Though it’s not very common, some individuals with lupus could develop optic neuritis. This condition occurs when the covering around the optic nerve becomes inflamed. Typically, only one eye is actually affected, but significant damage to vision can occur. Due to the fact that lupus often causes atrophy in the optic nerve, optic neuritis is closely related to lupus.
Another nerve disease that can occur with the eyes in individuals with lupus is optic neuropathy. This occurs when the blood vessels that supply blood to the optic nerve become blocked, thereby causing a stroke like condition in the eyes.
The layer of blood vessels below the cornea, known as the choroid, can be affected in individuals with lupus. This can lead to significant losses of eyesight. In individuals with SLE, the inflammation in the choroid can cause the retina to detach.
In individuals with SLE, the cornea can have what is called recurrent epithelial cell breakdowns. This causes pain and tearing that may- or may not- improve throughout the day. Additionally, there can be presence of peripheral ulcerations in the cornea that indicate vasculitis, or active inflammation of the blood vessels in the eye. These conditions may occur along with any other changes that could happen in the cornea connected with dry eye syndrome.