About 1.5 million Americans have lupus, a disease in which the immune system attacks healthy cells in the skin, blood vessels, joints, nervous system, heart, and kidneys, and eyes, causing chronic inflammation. Here, optometrist Troy Bedinhaus, O.D. discusses multiple eye conditions associated with lupus.* 

Lupus-related eye diseases

Lupus can affect various parts of the eye through inflammation, blood clots, insufficient lubrication, etc. It can lead to:

• Nerve disease
• Retinal disease
• Scleral disease
• Dry eye disease
• Eyelid disease

On rare occasions, lupus can also lead to angle-closure glaucoma, a medical emergency requiring prompt attention to preserve vision.

Angle-closure glaucoma

In one case study, a 31-year-old woman developed angle-closure glaucoma due to choroidopathy, a disease involving the abnormal buildup of fluid in the eye’s choroid layer, located between the retina and sclera (the white of the eye). 

The woman’s choroidopathy stemmed from systemic lupus erythematosus (SLE), the most common form of lupus. She experienced four days of nausea, vomiting, fever, eyelid swelling, and reduced visual clarity.

Angle-closure glaucoma from SLE choroidopathy can be treated with anti-glaucoma and immune-suppressive therapies.

Nerve disease

Optic neuritis, or an inflamed membrane covering the optic nerve (the eye-brain connection), often causes severe damage in the affected eye. Optic neuropathy can also occur, in which blood vessels supplying the optic nerve become blocked. This is sometimes called an “eye stroke.” An eye stroke is also a medical emergency requiring immediate care.

Steroid injections are typically used for treating both conditions, with blood thinners used to prevent blockages in the unaffected eye.

Retinal disease

Lupus can also lead to retinal vasculitis or inflamed blood vessels in the retina, causing reduced blood supply. New blood vessels form in a vain attempt at self-repair (neovascularization), with the new vessels being weak and vulnerable to leakage and breakage.

• Retinal swelling, blind spots, and painless vision loss can result.
• Steroids taken by mouth or via intravitreal injection (into the gel of the eye) can treat the condition, while immune-suppressive therapies can address the underlying lupus.

Scleral disease

When the sclera becomes inflamed, it’s called scleritis. The condition can cause this tough, white, protective eye coating to thin over time, risking damage. In severe cases, vision loss can result from even minor eye trauma. Scleritis often causes:

• Pain,  
• Blurred vision, 
• Light sensitivity, 
• Eye redness and/or dark areas on the sclera.

Steroids taken by mouth or applied to the eye, along with non-steroidal pain relievers such as ibuprofen, can treat the condition.

Dry eye disease

Lupus can injure eye structures that lubricate the eye, such as tear glands and mucosal tissues, causing dry eye disease (DED), in which normal tear volume declines. This can gradually damage the cornea (clear dome covering the iris and pupil) and conjunctiva (clear membrane covering the inner eyelid and sclera).

DED produces a persistent gritty feeling, as well as eye pain, burning, itching, and light sensitivity. Artificial tears can lubricate the eye and prevent damage, and immune-suppressive therapies can address underlying lupus.

Eyelid disease

Lupus can also cause discoid lupus erythematosus (DLE), a facial rash that can affect the eyelids, as well as ears, scalp, and sometimes other body parts. DLE:

• Consists of disc-shaped, scaly lesions, 
• Tends to be inherited, and 
• Is seen in three times more women than men.

Sun exposure and smoking are triggers for DLE. Steroids taken by mouth or, if more severe, cortisone injections have been shown to be effective treatments.

*Bedinghaus, T. (2022, May 25). 5 Ways Lupus Affects the Eyes. Verywell Health. https://www.verywellhealth.com/lupus-and-the-eyes-3422110