Hanyang Med Rev.  2016 Aug;36(3):155-160. 10.7599/hmr.2016.36.3.155.

Ocular Manifestations of Systemic Lupus Erythematosus

• Cho H

• KMID: 2350365
• DOI: http://doi.org/10.7599/hmr.2016.36.3.155

Abstract

Systemic lupus erythematosus (SLE) is a complex connective tissue disease involving multiple organs including various ocular structures including the eyelid, orbit, ocular adnexa, sclera, cornea, retina, uvea, and optic nerve. Keratoconjunctivitis sicca is the most common ocular manifestation resulting in patients that suffer from dry eye symptoms, whereas severe vaso-occlusive lupus retinopathy is the most vision-threatening condition associated with the disease. SLE is a serious systemic disease that may first present with ocular manifestations. In addition, ocular manifestations are often associated with severe systemic inflammation and can be a marker for systemic prognosis. Thus, it is important for ophthalmologists to be aware of the association of visual disorders with SLE to detect and treat the ocular manifestations of SLE.

Keyword

Systemic Lupus Erythematosus; Vasculitis; Choroidopathy; Keratoconjunctivitis sicca

MeSH Terms

Connective Tissue Diseases
Cornea
Eyelids
Humans
Inflammation
Keratoconjunctivitis Sicca
Lupus Erythematosus, Systemic*
Optic Nerve
Orbit
Prognosis
Retina
Sclera
Uvea
Vasculitis
Vision Disorders

Figure

• 

  Fig. 1 Schirmer test. The test is used when a person experience dry eyes or excessive watering of the eyes. Paper strips inserted into the fornix of the eye for 5 minutes (A). The paper is then removed and the amount of moisture is measured (B). A young person normally moistens 15 mm of each paper strip. Because hypolacrimation occurs with aging, 33% of normal elderly persons may wet only 10 mm in 5 minutes. Persons with Sjögren's syndrome moisten less than 5 mm in 5 minutes.

• 

  Fig. 2 A 37 years old female patient who presented first left visual dimness before the diagnosis of systemic lupus erythematosus (SLE). Her right (A) was calm but, her left eye showed multiple artery and vein occlusion with multiple cotton wool patches and retinal hemorrhages (B) at first. The patient was refered to the department of rheumatology and SLE was diagnosed. The fluorescein angiograms (C, D) revealed the extensive capillary nonperfusion and vascular occlusion in her left eye (D). After 3 months, the vaso-occlusive lupus retinopathy developed in the right eye also (E, G), fortunately it was relatively mild because the treatment for SLE began already. The neovascularization developed as a complication of vaso-occlusive retinopathy in her left eye (F). The leakage of neovascularization of disc was detected on the fluorescein angiogram of left eye (H). The laser photocoagulation started for the treatment of proliferative condition.

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