5 Ways Lupus Affects the Eyes

Dry Eye Disease

Lupus can damage tear glands, tear ducts, and the mucosal tissues that help lubricate the eye. This can lead to a condition called keratoconjunctivitis sicca, also known as dry eye syndrome.

Dry eye syndrome causes a persistent gritty sensation in the eye or under the eyelid. Eye pain, itching, burning, and light sensitivity are also common.

With dry eye syndrome, normal tear volume is decreased. Over time, this can cause damage to the cornea (the clear dome in the front of the eye) and conjunctiva (the clear membrane that lines the eyelid and loops back over the white of the eye).

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

Discoid Lupus Erythematosus

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 fort more severe cases.

Retinal Vasculitis

Retinal vasculitis is a complication of lupus in which 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 referred to as 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.

Optic Neuritis or Neuropathy

Less commonly, people with lupus may develop optic neuritis. Optic neuritis is an 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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