5 Ways Lupus Affects the Eyes

Lupus is an autoimmune disease that affects the skin, blood vessels, joints, heart, kidneys, and nervous system. Lupus occurs when the body's immune system attacks its own tissues and organs, causing chronic inflammation as well as the occasional flare-up of acute symptoms.

Lupus can also affect the eyes. It cause changes to the eyes, eyelids, tear glands, and tear ducts as well as the nerves and blood vessels servicing the eyes. This can lead to eye pain, dry eyes, change in visions, and vision los.

This article describes five complications of lupus-associated eye disease and what can be done to alleviate symptoms and avoid serious eye damage.

Five eye problems associated with lupus
Illustration by JR Bee, Verywell  
1

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.

Recap

Lupus can affect the tear glands and tear ducts, leading to dry eye syndrome (keratoconjunctivitis sicca). Artificial tears and immunosuppressant drugs may be used to treat the symptoms as well as the underlying autoimmune response.

2

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.

Recap

Lupus can cause the outbreak of disc-shaped lesions called discoid lupus erythematosus. The eyelids are often affected along with the face, ears, and scalp. Oral steroids may be prescribed to help relieve symptoms.

3

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.

Recap

Lupus can cause inflammation of the blood vessels of the retina, leading to retinal vasculitis. The condition can be treated with oral steroids or with an injection of steroids into the inner gel of the eye.

4

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.

Recap

Lupus can cause the inflammation and gradual thinning of the white of the eye, referred to as scleritis. Scleritis can be treated with oral or topical steroids as well as nonsteroidal anti-inflammatory drugs to help ease pain.

5

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.

Recap

Lupus can affect the optic nerve (causing optic neuritis) or the blood vessels servicing the optic nerve (causing optic neuropathy). Both are serious conditions that may require intravitreal steroid injections and other treatments.

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Summary

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

Among the eye conditions linked to lupus are:

  • Dry eye disease (keratoconjunctivitis sicca)
  • Discoid lupus erythematosus
  • Retinal vasculitis
  • Scleritis
  • Optic neuritis
  • Optic neuropathy

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.

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3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Shoughy SS, Tabbara KF. Ocular findings in systemic lupus erythematosusSaudi J Ophthalmol. 2016;30(2):117–121. doi:10.1016/j.sjopt.2016.02.001

  2. Lupus Foundation of America. How lupus affects the eyes.

  3. Md Noh UK, Zahidin AZ, Yong TK. Retinal vasculitis in systemic lupus erythematosus: an indication of active diseaseClin Pract. 2012;2(2):e54. doi:10.4081/cp.2012.e54

Additional Reading
  • R. R. Sivaraj, O. M. Durrani, A. K. Denniston, P. I. Murray and Caroline Gordon. Ocular Manifestations of Systemic Lupus Erythematosus. pp 1757–1762.