Journal of Eye Diseases and Disorders

Ocular Manifestations of Systemic Lupus Erythematosus: Diagnostic and Prognostic Significance

Eliana Costa^* Department of Autoimmune Ophthalmology, University of Coimbra, Coimbra, Portugal
^*Correspondence: Eliana Costa, Department of Autoimmune Ophthalmology, University of Coimbra, Coimbra, Portugal, Email:

Received: 03-Mar-2025, Manuscript No. JEDD-25-29168; Editor assigned: 05-Mar-2025, Pre QC No. JEDD-25-29168 (PQ); Reviewed: 19-Mar-2025, QC No. JEDD-25-29168; Revised: 26-Mar-2025, Manuscript No. JEDD-25-29168 (R); Published: 02-Apr-2025, DOI: 10.35248/2684-1622.25.10.271

Description

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies and multi-organ involvement, ranging from dermatologic and musculoskeletal symptoms to renal and neurological manifestations. Among the various organ systems affected, ocular involvement is often underappreciated but can provide important diagnostic clues and serve as a marker of disease activity. The spectrum of ocular manifestations in SLE is broad, encompassing both anterior and posterior segment pathologies, with varying degrees of severity and implications for vision and overall prognosis.

One of the most common ocular presentations in SLE is keratoconjunctivitis sicca, or secondary Sjögren’s syndrome, resulting from lymphocytic infiltration of the lacrimal glands. Schirmer’s test and tear breakup time are useful in confirming tear deficiency, and management typically involves lubricants, anti-inflammatory eye drops, and punctal occlusion in refractory cases.

Episcleritis and scleritis are less common but significant ocular complications of SLE. Episcleritis presents with localized redness and mild discomfort, while scleritis is characterized by severe pain, deep redness, and potential vision loss. Scleritis in SLE may be necrotizing and is often associated with systemic vasculitis. Prompt recognition and treatment with systemic corticosteroids or immunosuppressants such as cyclophosphamide or azathioprine are essential to prevent ocular and systemic morbidity.

Retinal involvement in SLE, particularly lupus retinopathy, reflects underlying microangiopathy and is strongly correlated with systemic disease activity. The most frequent findings include cotton wool spots, retinal hemorrhages, vascular tortuosity, and arteriolar narrowing. These changes are due to immune complex deposition, complement activation, and subsequent vascular occlusion. In severe cases, retinal artery or vein occlusions may occur, leading to sudden and profound vision loss. Fluorescein angiography and Optical Coherence Tomography (OCT) aid in evaluating the extent of retinal ischemia and guiding treatment.

Choroidopathy, though rare, is a severe and sight-threatening manifestation often associated with active lupus nephritis or central nervous system involvement. It typically presents with serous retinal detachments, choroidal thickening, and leakage on fluorescein angiography. The pathogenesis is thought to involve immune complex-mediated choroidal vasculitis and breakdown of the retinal pigment epithelium. High-dose systemic corticosteroids and immunosuppressive therapy are required, and the ocular findings often mirror systemic disease response.

Neuro-ophthalmic manifestations such as optic neuritis, cranial nerve palsies, and papilledema may indicate central nervous system lupus and necessitate urgent evaluation. Optic neuritis presents with sudden vision loss, pain on eye movement, and an afferent pupillary defect, often requiring pulse corticosteroids and long-term immunosuppression. Ischemic optic neuropathy may also occur due to small vessel vasculopathy, particularly in patients with Antiphospholipid Syndrome (APS), a known complication of SLE.

The presence of antiphospholipid antibodies in SLE patients further increases the risk of thrombotic ocular events, including retinal vascular occlusions and anterior ischemic optic neuropathy. APS-associated ocular findings often occur in young patients without traditional vascular risk factors and require lifelong anticoagulation therapy in addition to immunosuppressive treatment. These cases underscore the need for a multidisciplinary approach to management involving rheumatologists, ophthalmologists, and hematologists.

Diagnosing ocular lupus can be challenging due to its diverse manifestations and overlap with other autoimmune or infectious conditions. Laboratory tests including ANA, anti-dsDNA, complement levels, and antiphospholipid antibodies, along with detailed systemic and ocular examinations, are crucial for accurate diagnosis and risk stratification. Imaging modalities such as OCT, fundus autofluorescence, and MRI of the orbit and brain enhance diagnostic precision in complex presentations.

Management of ocular lupus requires individualized therapy based on disease severity, organ involvement, and response to treatment. Topical therapies are sufficient for mild anterior segment disease, whereas posterior segment and neuro-ophthalmic manifestations demand systemic immunosuppression. Biological agents such as rituximab and belimumab are being explored in refractory cases with encouraging results, though data on their specific ocular efficacy remain limited.