Systemic lupus erythematosus (SLE) is a chronic, relapsing autoimmune disease that affects various organs. About one third of patients develop eye involvement, which correlates with disease activity.
Like the systemic manifestations, the ocular manifestations can be very variable. The most common eye involvement in SLE is the dry eye syndrome (keratoconjunctivitis sicca), caused by inflammation of the lacrimal gland. Depending on the severity of the symptoms, therapy can vary from local wetting with eye drops to systemic immunosuppressive drugs. Other surface involvement includes swelling of the eyelid, redness of the eyelid, inflammation of the eyelid margin and conjunctivitis. Less common causes of eye redness in SLE are inflammation of the connective tissue layer between the conjunctiva and the sclera (episcleritis) and inflammation of the sclera (scleritis). More rare causes of eye redness in SLE are inflammation of the iris (uveitis) and corneal inflammation.
If the retina is involved
Retinal involvement (SLE retinopathy) is found in about 5% of patients and may occur in association with choroidal involvement (chorioidopathy). SLE retinopathy correlates with the activity of systemic and cerebral SLE and is explained by two mechanisms: direct effect of the vascular inflammation (vasculitis) by the Autoimmune process and indirect effect of the secondary hypertension resulting from the renal damage. Through these two mechanisms, numerous retinal and choroidal findings can develop, causing loss of vision.
When the central nervous system is involved
In some cases there are also Eye movement disorders with double vision. They may be caused by local inflammation of the eye muscles (myositis) or by involvement of the central nervous system. The most common sign of central nervous system involvement is considered to be inflammation of the optic nerve (optic neuritis) in the first place, in 1% of cases, followed by ocular myasthenia, visual field loss and swelling of the optic nerve in the context of chronic cerebrospinal fluid pressure (pseudotumour cerebri).
Since ocular manifestation can be the first clinical sign of the disease, good interdisciplinary cooperation is a prerequisite for successful treatment. Early diagnosis and treatment are crucial to avoid permanent visual impairment.
