Ocular manifestations of systemic lupus erythematosus

Abstract

Ocular manifestations of lupus are fairly common, may be the presenting feature of the disease and can be sight-threatening. Almost any part of the eye and visual pathway can be affected by inflammatory or thrombotic processes. Ocular pain and visual impairment require urgent assessment by an ophthalmologist. Infection should be excluded. Optic neuritis and ischaemic optic neuropathy may be difficult to distinguish. Scleritis and severe retinopathy require systemic immunosuppression but episcleritis, anterior uveitis and dry eyes can usually be managed with local eye drops. Vaso-occlusive disease, particularly in the presence of antiphospholipid antibodies, requires treatment with anticoagulation and proliferative retinopathy is treated with laser therapy. Hydroxychloroquine rarely causes ocular toxicity at doses under 6.5 mg/kg/day. When this has occurred, it has been associated with more than 5 years of drug exposure.

Acute onset myopia – A rare presentation of systemic lupus erythematosus

“…In this case the mechanism seems to be the forward displacement of the iris lens diaphragm due to choroidal effusion, 3 as confirmed the changes in anterior chamber depth. Ciliochoroidal effusion and retinal folds were confirmed on ophthalmic ultrasonography and fundus photograph respectively.…”

“…Laboratory examination revealed Hb e 8.7 gm%, TLC e 3200/mm, 3 Platelets e 1, 50,000/ml, Serum Urea/Creatinine e 56 mg/dl/1.2 mg/dl, Serum uric acid e 6.3 mg/dl, Serum Na þ / K þ e 125/4.6 mEq/l. Urine routine and microscopy showed proteins 3þ, 2e3 RBCs, numerous WBCs with granular casts with 24 h urine protein being 350 mg/dl.…”

Ocular Manifestations in Systemic Lupus Erythematosus

“…These include immune complex deposition and other antibody related mechanisms, vasculitis, and thrombosis [5]. Cytokine dysregulation, polyclonal B-cell activation, autoantibody production, and increased immune complex formation due to aberrations involving hyperactive B cells, T cells, and cells of the monocytic lineage are also postulated [6].…”

“…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].…”

“…Eyelid disease: Discoid lupus rash over the eyelids present as discrete raised scaly lesions [5], which are often mistaken for chronic blepharitis and eczema, and may lead to permanent sequelae such as madarosis and cicatricial ectropion. Lupus rash of this site is rare compared to other sun-exposed areas such as the head, the face, and the neck [4].…”