Ocular Complications in Cutaneous Lupus Erythematosus: A Systematic Review with a Meta-Analysis of Reported Cases

Abstract

Ocular complications associated with cutaneous lupus erythematosus (CLE) are less studied compared with those ones associated with systemic lupus erythematosus (SLE). The main ocular sites involved in patients affected by discoid lupus erythematosus (DLE) are eyelids followed by orbit and periorbit, the least being cornea. The most common complications are blepharitis usually affecting the lower lid and associated with some type of lid lesion such as plaque or erythematosus patches and madarosis. Few cases with LE profundus (LEP) and ocular complications are reported, but they are associated with orbital inflammatory syndrome and severe complications. The main treatment prescribed is hydroxychloroquine with a dose of 200 mg twice a day for 6 to 8 weeks. Corticosteroids are also used. Intervals between the correct diagnosis and the beginning of the ocular symptoms are commonly delayed. Ophthalmologist should be aware of the ocular manifestation of this autoimmune disease.

A Case of Tolosa-Hunt Syndrome With Discoid Lupus Erythematosus

“…Ocular complications of DLE typically manifests as lesions on the eyelids or with conjunctivitis, both of which this patient did not have, suggesting he had both DLE with active lesions in addition to THS. 9 This unusual occurrence of THS and DLE prompts consideration of nonsystemic autoimmune disorders in diagnosis of THS.…”

Periorbital swelling and episcleritis may be a sign of cutaneous lupus erythematosus

“…Periorbital edema is a rare presentation of CLE . A review of 77 patients with CLE and ocular findings by Arrico et al revealed that the main ocular site involved is the eyelids in 63 patients (88.7%) followed by orbit and periorbital tissues in six (8.4%) and cornea in two (2.6%). These findings were most common in discoid lupus erythematosus (DLE) (92.2%) followed by lupus erythematosus profundus (7.8%) …”

Treatment of lupus erythematosus of the eyelids with pulsed dye laser

“…Discoid lupus erythematosus (DLE) is the most common form of CCLE, generally involving the face (forehead, philtrum, malar region, nose, ears, and cheek) in a longstanding and disfiguring way [3].…”

“…Blepharitis and infiltrated erythematous plaques, with skin atrophy, scarring, and telangiectasia are most frequently observed [3,4]. The lower eyelid is also commonly affected, usually with loss of eyelashes (madarosis) [3].…”

“…Topical tacrolimus and pimecrolimus have also described as effective [3,4]. If lack of response occurs, other systemic immunosuppressive drugs may be tried [6].…”