Can Lupus Affect Your Eyes and Vision?

Lupus is an autoimmune disease that attacks your body’s immune system, including the tissues and organs. There are four kinds of lupus:

• Systemic lupus erythematosus (SLE). The most common type of lupus that can affect various parts of the eye, resulting in vision impairment or blindness.
• Cutaneous lupus. Cutaneous lupus is limited to the skin.
• Drug-induced lupus. This kind is brought on by certain prescription drugs.
• Neonatal lupus. A rare kind of lupus that typically affects infants of mothers with lupus. However, about 60% of women whose child has neonatal lupus may not have lupus themselves.

How Can Lupus Affect Your Eyes?

Lupus can affect the eyes in various ways, causing symptoms and complications that may impact vision and overall eye health. These effects occur due to inflammation and immune system dysfunction associated with lupus.

Below are the main ways lupus can affect the eyes:

1. Dry Eye Syndrome (Keratoconjunctivitis Sicca)

Lupus can cause inflammation in the tear glands, leading to reduced tear production and dry eye syndrome. Symptoms include:

• Redness
• Irritation
• Burning
• A gritty sensation in the eyes

2. Retinal Issues

Lupus is associated with two main retinal issues, the first of which is lupus retinopathy. This condition causes inflammation and damage to the blood vessels in the retina, resulting in retinal hemorrhages or vision loss.

The second type of retinal issue is central serous retinopathy. This occurs when stress or corticosteroid use causes fluid to accumulate under the retina, causing blurred or distorted vision.

3. Optic Nerve Damage

Optic neuritis is inflammation of the optic nerve, which can result in pain, vision loss, or changes in color vision.

Meanwhile, ischemic optic neuropathy is the reduced blood flow to the optic nerve due to vasculitis or thrombosis. This can cause sudden vision loss.

4. Scleritis and Episcleritis

Lupus can cause inflammation of the sclera (the white part of the eye) or episclera (the outer layer of the sclera).

Scleritis leads to severe pain, redness, and potential vision impairment, while episcleritis is typically milder.

5. Uveitis

Inflammation of the uvea (middle layer of the eye) can occur, leading to redness, pain, light sensitivity, and blurry vision.

6. Medication Side Effects

Medications used to treat lupus, such as hydroxychloroquine (Plaquenil), may cause retinal toxicity with prolonged use. This condition can lead to permanent vision loss if not monitored regularly.

7. Secondary Conditions

Lupus increases the risk of blood clots, which can block blood vessels in the eyes and result in sudden vision problems. Aside from that, hypertension caused by lupus-related kidney issues or medication side effects can also damage blood vessels in the eyes.

How to Manage Eye Health with Lupus

Living with lupus can feel like a constant balancing act, and managing its impact on your eyes is no exception. But don't worry, there are ways to protect your eyesight:

• Regular checkups. Prioritize eye exams with an ophthalmologist. These exams help detect any early signs of lupus-related eye conditions, allowing for timely treatment and preventing further damage.
• Know your medications. Some medications, like hydroxychloroquine, are used to treat lupus and can have eye-related side effects. Regular eye exams are crucial if you're on this medication.
• Stay informed. Don't hesitate to ask your doctor questions and stay updated on the latest research and recommendations.
• Track your eye health. Keep a journal to record any changes in your vision or eye comfort. This can be a valuable tool for sharing with your doctor during your checkups.
• Manage dry eyes. Consider using artificial tears, lubricating ointments, or warm compresses. Your doctor might also recommend prescription eye drops or punctal plugs to help retain moisture.
• Protect your eyes. When outdoors, wear sunglasses that block UV rays to shield your eyes from sun damage. If you work on a computer, take frequent breaks to reduce eye strain.
• Maintain a healthy lifestyle. Eating a balanced diet, staying hydrated, and managing stress can contribute to overall eye health and well-being. Consume more omega-3-rich foods to improve tear production and reduce inflammation.

When Should You See an Eye Doctor?

If your symptoms don’t improve or worsen over time, see a doctor. Your doctor can help you treat your lupus symptoms.

Lupus treatment consists of immunosuppressive drugs, like hydroxychloroquine and corticosteroids. These inhibit immune system activity.

The FDA also approved belimumab in 2011. This is the first drug to treat SLE lupus in more than five decades.

What Kinds of Healthcare Professionals Should You See?

Ophthalmologists are eye specialists trained to diagnose and treat various eye conditions, including those related to lupus. They can provide specialized care and monitoring to ensure your eyes stay healthy.

Rheumatologists manage the overall treatment of lupus and play a vital role in controlling the underlying inflammation that can affect the eyes.

Lastly, your primary care physician can provide general eye care and coordinate with your specialists to ensure comprehensive management of your lupus and its effects on your eyes.

How is Lupus-Related Eye Damage Treated?

Lupus-related eye damage treatment depends on the specific problem and its severity. It often requires a team effort of rheumatologists and ophthalmologists.

These are the main treatment strategies:

• Corticosteroids. These are meant to control inflammation in conditions like uveitis, scleritis, or optic neuritis.
• Immunosuppressive drugs. These may be prescribed to control systemic lupus activity that affects the eyes.
• Biologics. Drugs like rituximab or anifrolumab (approved for lupus) may be considered for severe or refractory cases.
• Eye-specific treatments. Depending on the condition, these can include artificial tears, anticoagulants, and the abovementioned medications.
• Monitoring. Regular eye exams (every 6 to 12 months) are essential for early detection of retinal toxicity caused by long-term medication use.
• Supportive therapies. Protective eyewear and avoiding UV light can help minimize symptoms. Regular follow-ups with an ophthalmologist are critical for monitoring disease progression and treatment efficacy.
• Advanced treatments. For severe and stubborn dry eye, sewer treatments like those using mesenchymal stem cells show promise in improving corneal health.

Remember, managing eye health with lupus requires a multi-faceted approach. By working closely with your healthcare team, adopting healthy habits, and staying proactive, you can protect your vision and enjoy a fulfilling life despite the challenges of lupus.