What Are the Symptoms of Lupus In the Eyes?

Lupus can affect the eyes, eyelids, the skin around the eyes, and the nerves and blood vessels supplying the eyes. About one-third of people with lupus experience eye problems. The most common lupus eye problem is dry eye syndrome, affecting about 25% of people with lupus.

People with dry eyes due to lupus may experience eye irritation, redness, and pain, an open sore on the cornea (corneal ulcer), and a sensation of something stuck in the eye. About 10% of people with lupus develop retinal disease, which can lead to vision loss and blindness. As with most lupus symptoms, lupus-related eye problems range from mild to severe.

Dry Eye Disease

People with lupus commonly develop dry eye syndrome (keratoconjunctivitis sicca). In fact, as many as 25% of people with lupus eventually develop dry eyes.

Dry eye syndrome develops in people with lupus when the immune system attacks the lacrimal glands, or the glands responsible for making tears.

When the lacrimal glands get damaged, the eyes lose their ability to self-lubricate, leading to dry and inflamed eyes. Eye pain, itching, burning, and sensitivity to light are also common.

Artificial tears are commonly prescribed to lubricate the eyes and prevent eye damage. Immunosuppressant drugs may be used to treat the underlying autoimmune response.

Corneal Ulceration

Another complication of lupus affecting the eyes is corneal ulceration. The cornea is the clear, outer layer of the eye that helps focus light so you can see clearly.

In people with lupus, corneal ulceration usually develops as a result of dry eye syndrome. Over time, dryness and increased friction can damage the cornea, making it more vulnerable to cuts and scratches.

Tears contain essential nutrients that protect the cornea and help it heal. Without enough tears, the cornea takes longer to repair itself, increasing the risk of ulcers and infections.

If the corneal ulceration is infected, it may be treated with antibiotic, antifungal, or antiviral eye drops, depending on the type of infection.

Corticosteroid eye drops may be prescribed to reduce inflammation. Lubricating eye drops may also be prescribed to keep the eye moist and promote healing.

Discoid Lupus Erythematosus

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People with lupus often develop a skin condition called discoid lupus erythematosus which appears as a thickened rash over the eyelids.

The rash is made up of scaly, disc-shaped lesions that mostly appear on sun-exposed areas of skin. The condition tends to favor the face, ears, and scalp but can develop on other parts of the body.

Discoid lupus erythematosus tends to run in families, with females outnumbering males three to one. Cigarette smoking and sun exposure can trigger an outbreak.

The discoid lesions usually respond well to oral steroids, although cortisone injections may be used for more severe cases.

Retinal Vasculitis

Retinal vasculitis is a complication of lupus in which the blood supply to the retina is reduced. Vasculitis refers to the inflammation of blood vessels.

The retina is the layer of cells on the back of the eye that senses light and sends signals to the brain so that you can see.

When retinal vasculitis occurs, the retina tries to repair itself by creating new blood vessels (a process called neovascularization). Unfortunately, the new blood vessels are weak and prone to breakage or leakage. This can cause swelling of the retina, leading to blind spots and a painless decrease in vision.

Oral steroids or intravitreal steroid injections (delivered to the inner gel of the eye) may be used to treat retinal vasculitis. Immunosuppressant drugs can help treat the underlying autoimmune response.

Scleritis

Lupus can also cause scleritis. The sclera is the white, tough outer coating of the eyeball. Scleritis occurs when the sclera becomes inflamed. Over time, scleritis can cause the sclera to thin, creating weakened areas that can perforate.

For most people, scleritis causes pain, light sensitivity, blurred vision, eye redness, or dark patches on the sclera. But when scleritis is severe, even a minor trauma can cause serious eye damage and a loss of vision.

Scleritis can be treated with oral or topical steroids along with nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) that help ease eye pain.

Uveitis and Choroiditis

Uveitis refers to inflammation of the uvea, or the middle layer of the eye between the sclera and the retina. Up to 5% of people with lupus develop uveitis.

In people with lupus, uveitis typically manifests in the form of choroiditis, or inflammation of the choroid. Located towards the back of the uvea, the choroid is responsible for supplying the retina with blood.

Choroiditis can eventually damage the blood vessels supplying the retina, sometimes causing the retina to detach from its supporting tissues (retinal detachment). Retinal detachment can lead to blindness unless treated promptly.

Choroiditis often responds well to systemic corticosteroids, which may be administered orally or by IV. Milder cases may be treated with corticosteroid eye drops administered directly into the affected eye. Prompt immunosuppressive therapy may also be necessary.

Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) is a medical emergency in which the main artery supplying blood to the retina gets blocked by a blood clot, causing sudden, partial or total vision loss in the affected eye.

CRAO usually happens in people with lupus who also have antiphospholipid artery syndrome, an autoimmune disorder when the immune system attacks proteins in the blood that regulate blood clotting. CRAO is considered a form of ischemic stroke.

Treatment may involve medications to reduce eye pressure or dissolve blood clots. A procedure called ocular massage may be done shortly after CRAO occurs to gently dislodge the clot and restore blood flow.

Even with treatment, fewer than 20% of people who experience CRAO regain their vision in the affected eye.

Optic Neuritis or Neuropathy

Less commonly, people with lupus may develop optic neuritis. Optic neuritis refers to inflammation of the membrane around the optic nerve, which can lead to tissue death (atrophy). While only one eye is usually affected, the damage can often be severe.

Optic neuropathy is a similar condition that causes the blockage of blood vessels servicing the optic nerve. Some people refer to this as an eye stroke. An eye stroke is a serious medical condition that requires immediate medical care.

Intravitreal steroid injections are commonly used to treat both conditions. With optic neuropathy, anticoagulants (blood thinners) may be prescribed to prevent blockages in the unaffected eye.

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Summary

Lupus is an autoimmune disorder that targets and attacks different organs of the body, including the skin, joints, kidneys, blood vessels, and nervous system. When it affects the eyes, it can damage the eyelids, tear glands, cornea, conjunctiva, retina, and optic nerve.

The treatment of lupus-related eye conditions may be as simple as artificial tears. In other cases, oral steroids, topical steroids, or intravitreal steroid injections may be needed. Immunosuppressant drugs may also be prescribed to treat the underlying autoimmune response.