Ocular Manifestations of Systemic Lupus Erythematosus: A Review of the Literature

Abstract

About one-third of patients suffering from systemic lupus erythematosus have ocular manifestations. The most common manifestation is keratoconjunctivitis sicca. The most vision threatening are retinal vasculitis and optic neuritis/neuropathy. Prompt diagnosis and treatment of eye disease is paramount as they are often associated with high levels of systemic inflammation and end-organ damage. Initial management with high-dose oral or IV corticosteroids is often necessary. Multiple “steroid-sparing” treatment options exist with the most recently studied being biologic agents.

Ocular Manifestations in Systemic Lupus Erythematosus

“…The most common autoantibodies in patients with neuropsychiatric lupus however, were anticardiolipin antibodies [1]. Lupus is also strongly associated with defects in apoptotic clearance [10] Moreover, medications (such as hydralazine, D penicillamine, anti-TNFα inhibitor), hormonal influences (pre-puberty, puberty, pregnancy, menstrual cycle, menopause), and other factors such as sunlight have all been implicated in disease exacerbation [4]. Ultraviolet light is the most well described environmental trigger of systemic lupus erythematosus.…”

“…Multiple autoantibodies that have been implicated in the disease include autoantibody against double-stranded DNA, Ro, La, Sm, NMDA receptor, phospholipid, and α-actinin [4]. The explanations of tissue damage cause by autoantibodies have two major theories.…”

“…Depression of such complement factors is an independent risk factor for the development of SLE [15] Mass production of autoantibodies relies on multiple factors, which have each independently been targeted as a potential immunotherapy in the treatment of lupus. Important steps include T-cell activation via antigen binding to the Tcell receptor and proper co-stimulation; T-cell activation of B-cell; production of cytokines such as TNF-α, TNF-γ, IL-10, and B lymphocyte stimulator [4].…”

“…Ocular manifestations include eyelids, orbit, lacrimal system, ocular surface, glaucoma, cataract, uveitis, retinal vasculature, choroid, and cranial nerves [3][4][5]32]. The most common ocular involvement is dry eye syndrome or keratoconjunctivitis sicca, and the most common vision threatening condition is retinopathy [3][4][5].…”

“…The eye is not a primary target of immune mediated damage in SLE, but can be affected in a variety of ways resulting in significant ocular morbidity [3]. This can occur in up to one third of patients and it can be a marker for overall systemic disease activity [4]. Eye symptoms are easily neglected by patients who are overwhelmed with major organ involvement when their disease is active, but delayed diagnosis and treatment may lead to permanent eye damage and visual loss.…”