This month, Jonathan D. Solomon, MD answered your questions about how lupus may manifest in the eyes, and the possible impacts of lupus treatments on eye health.
1. Can you please explain the relationship between lupus and (re-occurring) Episcleritis? The Episcleritis is often noticed by others before me and occurs at the same time with a large skin rash on my body-not the face. Plymouth, MA
Episcleritis is another eye manifestation of lupus, and is a result of the auto-immune inflammatory disorder. Inflammation, which can present with focal redness and tenderness over the white part of the eye, and, even blurry vision are hallmarks of Episcleritis. This demands attention from an eye care provider.
2. Can retinal hemorrhaging found in the periphery be related to lupus and/or the drugs to treat it? If so, how can it be treated? Houston, TX
Inflammation associated with Lupus can be found in the retina, and specifically the retinal vessels, which may lead to bleeding. In addition, to screening and close surveillance of high-risk medications, like Plaquenil®, and other medications which are known to be very effective against auto-immune diseases; it is recommended that periodic dilated eye exams be performed to evaluate for any such issue that may be related to adverse effects of the medications, or the lupus itself. I would recommend an evaluation with an ophthalmologist for further consideration.
3. I’m on Plaquenil® and methotrexate, and have had scleritis /uveitis. I have also had ocular migraines, and my neurologist put me on Topamax. Being on this medication has helped tremendously with my sensitivity to lights and the migraines, but also my vision has seemed to become clearer. Is this coincidence? Or do you think the addition of Topamax helped the vision? Exeter, NH
Firstly, I am glad to hear that your vision has improved. As you know, Topamax® is a very effective medication for the treatment of headaches, and migraines specifically. “Triggers” are frequently avoided at any cost to prevent migraines-and bright lights are a common trigger. So if your “photophobia” has improved in addition to your vision, then this is clearly the correct combination for you. Kudos to you and your entire medical team!
4. I have lupus and Sjögren’s syndrome. My eyes are very dry. Why do the backs of my eyes hurt? Savannah, GA
The symptoms associated with dry eye disease, particularly aqueous deficiency dry eye or Sjogren’s syndrome, are varied and more often than not superficial. Intermittent blurry vision, foreign body sensation, light sensitivity, and redness are just a few symptoms that individuals describe. But the pain can be referred to different parts of the eye and orbit. With this in mind, the overwhelming majority of dry eye sufferers can be managed successfully, and the discomfort brought under control. I would strongly encourage you to seek a thorough ocular surface examination.
5. I had cataract surgery a year ago. My doctor just diagnosed me with lupus and wants to put me on Plaquenil®. Is this safe for me to take given the warnings about the drug and eye health, in addition to my history? Salem, IN
Prior to the administration of Plaquenil®, a baseline dilated retinal examination with an eye care provider is recommended. With that in mind, previous cataract surgery is not an absolute contraindication (reason to make use inadvisable) to Plaquenil.
6. I occasionally wake up with one red eye that will not go away with drops. I also have diagnosed dry eyes. Is this lupus related? Atlanta, GA
A number of studies have identified dry eye disease as the most common ocular manifestation of lupus. Furthermore, it is not uncommon for those who are battling lupus to battle another overlapping disease, such as Sjogren’s syndrome, which specifically targets the eyes. Both, however, can and should be managed by a specialist.
7. I have lupus and Sjögren’s syndrome. If you no longer produce tears due to Sjögren’s, is that in any way reversible? Is there any treatment that can help me produce tears again? I recently had Punctual Plugs placed and I’m also on prescription drops. Oakland Park, FL
Topical cyclosporine (Restasis® 0.05%) helps increase the eyes natural ability to produce tears, and recently approved, Lifitegrast (Xiidra™ 5%), also helps to address this issue. Both medications will allow for improvement in the symptoms and the signs of dry eye by addressing the inflammatory components. These are just two different commercially available options. Other options may include amniotic membrane grafts, in addition to many other options to consider. You may want to seek consultation with a dry eye specialist.
8. I was told about 1 year ago that I have lupus. Now my blood pressure is very high and the doctor is recommending that I go to an eye specialist every 6 months for certain eye tests. My lupus is affecting my kidneys, so what does that have to do with my eyes? And is there a possibility I could go blind? Bayonne, NJ
It sounds like your doctor is trying to tell you to pay attention to your eyes. High blood pressure and poor renal function is serious. Listen to what your doctor is recommending, and please go see an ophthalmologist.
9. My rheumatologist has recommended that I see an eye specialist since I am on hydroxychloroquine. Which type of doctor should I see for my eye health? An ophthalmologist or an optometrist? I am very confused. Las Vegas, NV
As of 2011, the American Academy of Ophthalmology has revised guidelines for Plaquenil® screening. A baseline examination is recommended with an Ophthalmologist. Testing may include the following: color vision, dilated-retinal exam, SD-OCT, Humphrey Visual Field, and multifocal-ERG.
10. My daughter has lupus and has serious sensitivity to light. Recently, she had a terrible reaction to light and was unable to visually focus. Is this a sign her vision will get worse? And, is there something that can be done to combat the effects of sunlight and indoor classroom lighting? Casselberry, FL
“Photophobia”, sensitivity or fear of light is a common symptom for chronic dry eye. However, this does not speak to the severity of your daughter’s sensitivity to light, nor is photophobia specific to chronic dry eye disease. Other sources of eye inflammation can present with light sensitivity. Therefore, I recommend an evaluation with her eye care specialist as soon as possible.
11. About every 3-4 months I get a very painful and reddened eye. Sometimes it alternates eyes. The pain and redness last anywhere from 3 days to a week. I have had several eye exams. The doctors are unsure of the cause. Is this related to the lupus and what can be done for the pain? Akron, OH
Recurrent ocular inflammation is not uncommon with a backdrop of systemic lupus. Previous exams without a clear diagnosis, simply requires further examination until the diagnosis is found. A second, third, and subsequent opinion may be needed. But lupus and the manifestations of the eyes can often be elusive. So do not give up, and keep the faith in your eye care providers and let them know as much as you can about your symptoms. Try to get appointments to see them when your eye tends to flare, so the signs are easier to identify. Furthermore, there is a subspecialty of ophthalmologist that focuses on ocular inflammation, and you may want to seek one out.
12. Occasionally the white portion of my left eye swells a little and it “wrinkles” as I look sharply to the right. I used to have this problem after rubbing my eyes following a hay fever episode. This happens randomly, maybe for a few hours every week or so. Is it due to prolonged prednisone usage (15mg 10 months now)? Lawrenceville, GA
The conjunctiva (the thin layer of tissue that sits on the surface of the white part of the eye) may swell for a number of reasons or become redundant over time, causing intermittent irritation with eye movement.
13. I was reading an article about pink eye and it said rheumatoid arthritis and lupus patients tend to get pink eye. Is this true? And do you happen to know what the reason is for this? New York, NY
A “pink eye,” or conjunctivitis, is most often caused by a virus, less so bacteria and allergies. Other less commonly seen causes of a red eye, like Episcleritis or scleritis, can be seen in the setting of rheumatoid arthritis and lupus.
14. Can you lose your eyesight from lupus? Philadelphia, PA
With continued care, we would hope to make this a very unlikely outcome. However, it should be said that if left untreated, lupus related eye inflammation can cause severe vision loss. So please remember to keep going to your regularly scheduled eye exams.
15. Does discoid lupus have an effect on your eyesight? East Orange, NJ
Ocular involvement is uncommon. Yet the rare case of inflammation of the lower lid has been reported, as well as isolated cases of conjunctivitis. But I would never say never, and recommend an evaluation with an eye doctor if there is a concern for a threat to vision.