Epidemiology of disease-activity related ophthalmological manifestations in Systemic Lupus Erythematosus: A systematic review

Abstract

Objective Ophthalmic complications in Systemic Lupus Erythematosus (SLE) are broad and can occur in up to a third of patients. The British Isles Lupus Assessment Group (BILAG) 2004 Index identifies 13 ocular manifestations of active SLE, as opposed to those related to previous disease activity and/or the consequences of therapy. We conducted a systematic review of published literature to determine the frequency of ophthalmic manifestations of active SLE. Methods A systematic literature search of Ovid MEDLINE and EMBASE from their respective inceptions to July 2020 was conducted to identify cohort, case–control and cross-sectional studies. Results 22 studies meeting eligibility criteria were included. Most studies featured small sample sizes and were judged to have a high risk of methodological bias. The number and quality of studies did not allow us to confidently estimate the incidence of the conditions. No studies reported epidemiological data for orbital inflammation/myositis/proptosis. The prevalence of each of the other ocular manifestations, with the exception of retinal vaso-occlusive disease, was consistently less than 5%. Retinal vasculitis, uveitis and isolated cotton wool spots tended to be associated with more active SLE disease. Conclusion The prevalence of eye disease due to SLE activity is uncommon, but clinicians should be aware that some conditions tend to be associated with more active systemic disease. Further studies to determine the incidence and risk factors for these ophthalmic manifestations are needed.

The full range of ophthalmological clinical manifestations in systemic lupus erythematosus

“…There are other important ocular manifestations of active SLE that are not considered in the BILAG criteria, which score activity in the last month across nine domains (constitutional, musculoskeletal, mucocutaneous, hematological, renal, abdominal, ophthalmic, cardiorespiratory, and abdominal). For example, intracranial hypertension has been reported in association with severe SLE and lupus nephritis (17), and may be associated with sight-threatening papilledema, as stated by Jawahar et al (18). Our current series is in accordance with their findings because we present herein a patient with bilateral papilledema who had a 14-year history of SLE treated by HCQ and who it was discovered suffered from IIH.…”

“…A recent 2021 systemic review involved a systematic literature search to identify cohort, case-control, and cross-sectional studies about the epidemiology of ophthalmological manifestations in active SLE. It showed that the prevalence of each of the ocular manifestations related to SLE, with the exception of retinal vaso-occlusive disease, was consistently less than 5% (18). The prevalence of episcleritis ranged from 0% to 4.2% in the studies referenced by Jawahar et al in their systemic literature search (19)(20)(21)(22).…”

Augenbeteiligung bei ausgewählten rheumatischen Erkrankungen – Klinik im Erwachsenenalter

“…Weitere Zeichen der Erkrankung können in Konjunktivitis, Keratitis, Skleritis, Uveitis, Retinitis, Optikusneuritis, Myositis und weitere Orbitaentzündungen bestehen [26]. Retinale Vaskulitis, Uveitis und isolierte Cotton-Wool-Herde korrelieren mit einem schweren SLE-Verlauf [27]. Patientenbetreuung und Therapiekonzeption (insbesondere Indikation zu und Auswahl von DMARDs, z.…”

“…Other signs of the disease may include conjunctivitis, keratitis, scleritis, uveitis, retinitis, optic neuritis, myositis, and other orbital inflammations [26]. Retinal vasculitis, uveitis, and isolated cotton wool spots correlate with a severe course of SLE [27]. Patient care and therapy design (in particular the indication for and selection of DMARDs, e.g., hydroxychloroquine) should take place in the context of close interdisciplinary dialog [28].…”

Targeting the Ophthalmic Diseases Using Extracellular Vesicles ‘Exosomes’: Current Insights on Their Clinical Approval and Present Trials

“…These ailments vary in severity and require different treatments, such as medications, corrective lenses, surgery, or a combination of approaches [1]. The prevalence of all other ocular manifestations, except for retinal vaso-occlusive disease, was consistently below 5% [2]. Common eye conditions encompass a range of ailments: cataracts, which cause blurry or reduced clarity vision by clouding the eye lens; glaucoma, marked by heightened eye pressure leading to optic nerve damage and potential irreversible vision loss; macular degeneration, impacting central vision through macular impairment; diabetic retinopathy, a diabetic complication damaging retinal blood vessels, often resulting in vision impairment or blindness; refractive errors like myopia, hyperopia, astigmatism, and presbyopia, necessitating corrective lenses or surgery; conjunctivitis, commonly known as "pink eye," inducing swelling in the eye's clear surface tissue; retinal detachment, a critical medical emergency where the retina detaches from underlying layers, requiring immediate attention to prevent permanent vision loss; strabismus, characterized by misaligned eyes affecting depth perception and potentially causing amblyopia if untreated in childhood; and dry eye syndrome, stemming from insufficient tear production or poor-quality tears, leading to discomfort and vision disturbances [2][3][4].…”