Lupus and the eye

Complications in patients with lupus require special attention

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Systemic lupus erythematosus (SLE) can cause serious ocular surface consequences, often requiring intensive treatment with artificial tear drops and anti-inflammatory topical medications, said Wojciech Luboń MD, Medical University of Silesia, Katowice, Poland. “In patients with SLE, ophthalmological examination is recommended at least once a year, and in a patient with severe symptoms, at least every six months,” Dr Luboń told the 22nd ESCRS Winter Meeting in Belgrade, Serbia. To examine the frequency and diversity of ocular surface disease in patients with SLE, Dr Luboń and his associates conducted a study involving 40 patients with the condition referred to an ophthalmic outpatient clinic. The patients included 36 women and four men with a mean age of 51.7 years. All underwent an ophthalmological examination including vision testing and the ocular surface disease index questionnaire. They found that 18 of 40 patients had moderate-to-severe dry eye symptoms and corneal epithelium symptoms. The most frequent symptoms were dryness sensation in 81%, ocular discomfort such as stinging burning pain and itching in 67% and foreign body sensation in 25%. Less common complaints were light hypersensitivity in 19%, and 10% with sticky eye in the morning. In addition, 40% of patients had decreased visual acuity. Refractive errors included myopia in 52.5%, hyperopia in 12.5% and astigmatism in 32.5% of patients. Furthermore, there was lens turbidity in 17.5% of patients, and degenerative changes in the vitreous body in 37.5%. The study also noted abnormalities in retinal examinations, including dry degenerative changes in 7.5%, and irregularities in the course and calibre of retinal venous and arterial vessels in 5% of cases. CONNECTIVE TISSUE DISEASE Dr Luboń noted that SLE is a connective tissue disease, 
the exact cause of which is not known. The condition often develops in people genetically susceptible to the disease after the activation of additional stimuli such as: infections, drugs and hormonal factors. The resulting auto-antibodies trigger an inflammatory process leading to the destruction of the affected organ. SLE commonly involves the joints, muscles, skin and mucous membranes. The disease can also involve the kidneys, heart, lungs and, as this study confirms, the visual system. Patients present varied symptoms of dry eye syndrome, including corneal abnormalities. The ocular surface disease is also associated with the use of chronic anti-lupus medication intake such as hydroxychloroquine or long-acting glucocorticoids. Patients with the condition often require intensive treatment with artificial tears and anti-inflammatory topical medication. Wojciech Luboń: wojciech.lubon@gmail.com