How Can Vitiligo Affect the Eyes?

While vitiligo mainly impacts the skin, it can also affect other body parts where melanocytes are present, such as the inner ears or the eyes.

When vitiligo impacts the eyes, it can cause changes to vision, eye color, and eye health. Experts recommend routine eye exams for people with vitiligo to help monitor any issues.

This article provides an overview of how vitiligo can impact the eyes.

How Does Vitiligo Affect the Eyes?

Melanocytes are responsible for giving our skin, hair, and eyes their color, but they also have other functions throughout the body.

For example, experts think that melanocytes in the eyes may help protect from damage, toxins, and inflammation. When these melanocytes are destroyed by the immune system due to a condition like vitiligo, some eye changes can occur.

Here’s what could happen to the eyes during the vitiligo process:

• Eye color could be impacted if melanocytes in the iris (the colored part of the eye) are affected.
• Vision changes could occur if melanocytes in the retinal pigment epithelium (a layer of the retina, the inner part of the eye that responds to light) are affected.
• Uveitis, a condition that causes eye inflammation, pain, and redness, could develop if melanocytes in the uveal tissue (middle region of the eye) are affected.

Studies suggest that when vitiligo patches are located on the face, the eyes are more likely to be impacted.

Demographic factors such as age and gender don't seem to be significant risk factors for vitiligo that affects the eyes.

Eye Color

Your eye color is determined by the melanin that's produced by melanocytes in the iris, which is the colored part of your eye. In general, more melanin means darker-colored eyes, while less melanin results in lighter-colored eyes. 

While it’s possible (but pretty rare) for your eye color to change subtly or gradually during adulthood, a sudden lightening of eye color is possibly due to a disease like vitiligo. This might look like a patchy lightening of one or both eyes to a grey or blue color.

Vision

It's considered to be less common, but vitiligo that affects the retina could lead to slight vision changes, though likely not complete vision loss.

Much more research is needed on the way vision changes may progress with vitiligo, but experts still recommend routine eye exams as part of a vitiligo patient’s care plan. This may be particularly important if vitiligo patches appear on the face and near the eyes.

It's also a good idea to receive vision screening, if accessible, before starting vitiligo treatment with phototherapy or topical steroids around the eyes. Some studies have noted that these treatments can have potential eye-related side effects.

Uveitis

If vitiligo causes damage to the uvea, it can lead to uveitis, a condition that causes:

• Eye inflammation, pain, or redness
• Light sensitivity
• Blurry vision
• Floaters (spots that appear to drift in front of your field of vision)

Studies show that uveitis seems to be one of the more commonly reported eye complications with vitiligo. There are several syndromes that include both uveitis and vitiligo in their presentation. It's typically successfully treated with prescription steroids to reduce inflammation, but left untreated, uveitis can lead to additional eye issues, such as vision loss, scarring, glaucoma, or cataracts.

Signs of Vitiligo

The main sign of vitiligo is a loss of skin color in patches, which can develop differently for everyone. For example, the lightened patches of skin may:

• Start to appear first on the hands, face, arms, feet, or genitals
• Form on other areas of the body, including the hair and insides of the nose, mouth, ears, or eyes
• Affect both sides of the body, like a mirror image, or just one part of the body
• Continue growing over time or remain the same size

Vitiligo Causes

While the exact cause of vitiligo is unknown, a combination of factors including genetics, autoimmunity, stress, skin damage, and chemical exposure likely contribute to vitiligo development.

• Genetics: In some cases, vitiligo appears to run in families. Experts have found a link between certain genetic abnormalities and a greater chance of developing vitiligo. It's estimated that around 30% of people with vitiligo have a family history of the condition.
• Autoimmune conditions: People who have an existing autoimmune disease, such as psoriasis, lupus, Hashimoto’s disease, rheumatoid arthritis, type 1 diabetes, or hypothyroidism, are more likely to develop vitiligo. Researchers theorize that vitiligo patients' immune systems develop antibodies that destroy the skin pigmentation cells.
• Environmental triggers: Research suggests certain external events or circumstances can trigger the development of vitiligo in people who are genetically predisposed to the disease. This includes incidents like a severe sunburn, extreme emotional or physical stress, skin trauma, and exposure to strong toxins or chemicals. These triggers may also cause an existing vitiligo case to worsen.

Other Symptoms of Vitiligo

Some people with vitiligo will only notice the loss of skin pigmentation, while others develop one or more of the additional signs of the disease, including:

• White or grey hair: Melanocytes in the hair follicles may also be damaged by vitiligo, causing premature white or grey hair on the scalp, eyebrows, eyelashes, or beard.
• Severe sunburns: The lightened patches of skin are more sensitive to sun exposure, which can cause painful, swollen, or blistered sunburns in those areas.
• Skin sensations: Some people report feeling irritation, itchiness, or discomfort in the affected areas of the skin.

Treatment

Getting treatment for vitiligo is a personal choice. There’s no cure for the condition, and treatment isn’t required unless it’s associated with another medical condition, such as vision changes or an autoimmune disease.

For people who do choose treatment, the goal is usually to reduce the appearance of the patches, particularly if they’re affecting a person’s quality of life. Options include:

• Prescription medications: Prescription medications: Topical and oral prescription medications, such as corticosteroids and Opzelura (ruxolitinib), may help slow the progression and restore pigment of discolored skin patches.
• Phototherapy (light therapy): Laser or lamp procedures done at a healthcare provider’s office carefully expose the skin to small amounts of ultraviolet A or B (UVA or UVB) light to help restore lost color.
• Repigmentation surgery: Surgical procedures can take unaffected skin from one area of the body and replace an area of skin that is affected by vitiligo (similar to skin grafting).
• Depigmentation: A drug known as monobenzone can help remove the remaining pigment from the skin surrounding the patches, making them less noticeable.
• Micropigmentation: This tattooing technique is usually performed on smaller areas of skin to help blend vitiligo patches to match the rest of the skin.
• Skin camouflage products: As a temporary solution, self-tanner or makeup concealer can help add an appearance of color back to the lightened patches. 
• Diet and lifestyle changes: More evidence is needed, but some research indicates that diet, supplements, and protecting your skin from the sun may help prevent color loss from getting worse.

Summary

Vitiligo develops when the immune system mistakenly attacks melanocytes, the cells that give our skin, hair, and eyes their color. While vitiligo’s main symptom is a patchy loss of skin coloring, this condition can also affect other parts of the body.

When vitiligo impacts the eyes, some people may experience slight changes to their eye color, vision, and eye health. Experts recommend monitoring this through regular visits to a healthcare provider who specializes in eye issues.

A Word From Verywell

Most health insurance plans don't come with vision benefits, making eye care inaccessible or unaffordable for many. If your healthcare provider has recommended that you receive routine eye care for vitiligo and you need help accessing or paying for care, know there are options. Consider checking out EyeCare America or the New Eyes program, which offer services like free or low-cost exams, prescription eyeglasses, or prescription eye medications to those who qualify.

In addition, groups like the Global Vitiligo Foundation, Vitiligo Support International, and MyVitiligoTeam can help provide resources and support or refer you to a local organization, if necessary.