Lupus and Vision Problems
Lupus SLE can affect every single organ in your body, eyes included. This can be very scary since we rely on our vision as one of our main ways to navigate the world — but there are many things you can do to take precautions and ensure you have healthy eyes.
Sjogren's Syndrome
Many people with lupus, myself included, also have secondary Sjogren’s (pronounced show-grins) syndrome. The hallmark symptom of Sjogren's is dry orifices, which includes the eyes. Although usually not dangerous, this can be incredibly uncomfortable, especially when it's severe.
If your eyes are feeling drier than normal, contact your rheumatologist and talk to him or her about the possibility of Sjogren’s. A lot of it is controlled by the same medication you may already take for lupus, but your doctor may prescribe extra eye drops or medication to make you more comfortable.
If you wear contacts, you may either have to discontinue use, limit your use or take a break until you can get your Sjogren’s under control. Contacts can dry and irritate your eyes, making the symptoms even worse.
Dry eye is typically associated with Sjogren’s, but may simply occur with lupus. If you have blurry vision (especially if it is better when you rub your eyes), red eyes, irritated eyes, feel as though you have sand in your eye or that it has been scratched, you may have dry eyes.
It is very important to speak to your doctor about these symptoms, as they can lead to long-term eye damage and in severe cases, vision changes or loss.
Medication Side Effects
A potential side effect of using Plaquenil over the long term is problems with your eyes that can lead to vision loss and deterioration known as retinal toxicity.
This means that the medication has built up in your system over time and created an issue with vision, usually poor vision for things up close. However, this is fairly rare and usually occurs over a long period of time.
Still, it is important to have your eyes checked at least once a year to ensure that they are still in fighting form. Your doctor will likely have you do a more in-depth exam than you do during a regular vision test, and it may involve having your eyes dilated to have a look inside of them.
Although it is a bit uncomfortable, it is definitely worth it to ensure things are operating properly. While it is uncommon, retinal toxicity is also irreversible, and prevention and detection is currently the only treatment.
Scleritis and Retinal Vascular Lesions
Like most parts of your body when you have lupus, your eyes themselves can become inflamed. This is called scleritis, which is incredibly painful and may lead to red eyes.
Essentially, it is the inflammation of the white of the eye, and may be reduced with medication that helps reduce inflammation in other parts of the body.
Lupus.org states that retinal vascular lesions, or blood vessel changes in the retina, are the most common eye involvement when it comes to lupus. This is characterized by the blood flow to the eyes becoming less than adequate, and can lead to severe vision impairment or even loss.
Many times, this is also caused by blood clots in the arteries or veins that flow blood to the eye, which affect its ability to filter light.
The only real symptom of this condition is a sudden vision change, as there is no pain associated with it. If left untreated, not only is it vision threatening, but it can also be life threatening if the condition is caused by a blood clot that continues to travel through the blood stream.
In some cases, vision will return back to normal, but in others, the vision will be lost forever. Retinal vascular lesions correlate with disease involvement and seem to be on the rise when people are the most ill.
Other Possible Conditions
Additionally, there are several other things that can occur with lupus SLE in relation to the eyes. One such condition is known as cranial nerve palsy, which is the loss of function of a nerve.
Depending on which nerve is affected, different ocular symptoms may occur and multiple nerves may be affected at the same time. Cranial nerve palsy may cause disruption in vision, droopy eyelids or abnormal or limited eye movement. It can also cause double vision and/or an extremely dilated pupil.
Speaking with your doctor will help you determine the best course of action, and in some cases, surgery may be the answer.
Lupus optic neuropathy is a more rare condition that can occur within the lupus population. Lupus.org estimates that this disorder only affects between one and two percent of lupus patients, making it a disease that shouldn’t be worried about too much.
However, lupus optic neuropathy can potentially be quite serious and may mimic the symptoms of multiple sclerosis (MS), which can be very scary.
Many people with this disease will have loss of color in their vision in addition to a progressive loss of vision. These symptoms will be very similar to MS, but a complete workup shows that it is not the same illness, making lupus optic neuropathy a bit different. Because it is so rare, there isn’t really much data on it and the prognosis currently is not very good for a return of vision.
Additionally, those with lupus may develop damage to nerves in the brain, which can cause everything from the loss of peripheral vision to the loss of main vision. It can also cause severe hallucinations, which can be very nerve-wracking and scary.
It is important to remember that these diseases which affect the eye seriously are typically only present when disease activity is at its peak — although Sjogren’s may occur at any time. It is important that you speak with your doctor about maintaining proper eye health and keeping a watch (no pun intended) on your vision to ensure your future is looking bright (pun intended!).
If you notice any changes to your vision, particularly sudden and dramatic changes, contact your rheumatologist and your eye doctor immediately. It may end up saving your vision, or your life.