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Lupus and Dry Eye Problems

Lupus is a form of chronic autoimmune disease that can be responsible for affecting everything from the blood vessels, to the skin, the heart, the joints, the kidneys, the nervous system, and even the eyes. While in a normal, healthy human body, the immune system will work constantly to fight off foreign invaders like bacteria and viruses, people who suffer with lupus have an abnormally functioning immune system that attacks healthy tissue when it really should be seeking out potentially damaging elements. Often, people who suffer from lupus experience periods of severe flare-ups and remissions, and during a flare-up, swelling and inflammation can occur throughout the body, causing pain, fatigue, and tissue damage.

Autoimmune Condition and Dry Eye Syndrome

Dry eyes are often a very common side effect of many autoimmune conditions. The reason for this is that autoimmune diseases can often interfere with the natural tear production and chemical levels within the body, leading to tears that are too watery, or simply drying out various parts of the body. Commonly, people who suffer from lupus don’t just experience the symptoms of dry eyes, but actually get something known as dry eye syndrome – a condition wherein the dry eye effects become highly severe, generally creating a sensation of sand or grit in the eyes, alongside feelings of burning or itching. Usually, when this happens, normal tear volume is decreased, and the overall health of the external parts of the eye such as the conjunctiva and the cornea is affected.

One of the most common complications of dry eyes in lupus patients is the progression of a disease known as Sjogren’s syndrome, which occurs along with symptoms of dry mouth, dry eyes, and arthritis. Although this syndrome is quite rare, it is more common in people suffering from lupus and other autoimmune diseases.

Sjogren’s Syndrome

Sjogren’s syndrome is a form of autoimmune disease that is typically characterized by dryness around the eyes and mouth. Usually, autoimmune diseases are defined by the fact that they produce abnormal quantities of extra antibodies in the blood that are directed to fight various tissues in the body. However, the misdirection of the immune system in these diseases leads to the inflammation and damage of healthy tissues. This particular autoimmune disease, which happens more commonly in people with lupus, inflames the glands in the body responsible for producing saliva and tears, which leads to decreased water production and dry eyes.

The type of Sjogren’s syndrome that is not associated with another connective tissue disease is often regarded as primary Sjogren’s syndrome. On the other hand, the type of this disease that is associated with another connective tissue disease such as lupus erythematosus is regarded as secondary Sjogren’s syndrome. Dryness in the mouth and eyes of people without or with Sjogren’s syndrome is often referred to as sicca syndrome.

The primary risk factor for the development of Sjogren’s syndrome is being a member of a family that already has autoimmune diseases, or suffering from an autoimmune disease such as lupus yourself. This doesn’t necessarily mean that if someone in your family is suffering from lupus you will definitely develop the disease. Instead, it simply means that you are more likely to suffer from Sjogren’s than someone in a family that has no experience with autoimmune diseases.

Other Examples of Eye Issues in Lupus

Eye dryness and related syndromes are not the only problem that can emerge in lupus patients. Indeed, these patients are frequently more susceptible to a wide range of different ocular diseases and conditions. For example, one common eye issue in lupus patients is uveitis – a condition wherein the uvea becomes inflamed, and other parts of the eye may begin to swell, such as the eyelids, the sclera, the retina, the iris, and even the optic nerve. Similarly, people with lupus can suffer from ocular conditions such as:

  • Conjunctival issues – this refers to inflammation of the conjunctiva, which covers the sclera and lines the eyelid. This inflammation happens because the blood vessels in that part of the eye begin to dilate, leading to itching and discomfort. Although conjunctival ulcers are very uncommon, they can also be found in people who have been diagnosed with lupus.
  • Discoid lupus – this is a very specific strain of lupus which can affect the skin, leaving rashes and scars. The skin of the eyelid is not protected from any of the other skin manifestations associated with lupus, and as a result discoid lupus may involve the eyelid, leading to dryness, pain, and even the loss of eyelashes.
  • Scleritis – the white portion of the eye that is otherwise known as the sclera can often become inflamed, causing a yellowish discoloration in certain areas. This condition is often quite unusual in people with lupus, but it can occur.
  • Vasculitis of the retina – in lupus, the retina is particularly involved in the disease. People who suffer from lupus are very likely to suffer with a problem known as retinal vasculitis, a disease which limits the supply of blood to the retina, thus affecting vision. Although the eye attempts to repair itself in these circumstances, blood vessels can form in the eye that impair vision.

Links Between Lupus Medication and Eye Problems

Many of the eye problems that are typically associated with lupus, including dry eye syndrome, can actually occur as a result of exposure to the drugs that doctors are using to treat lupus itself. In fact, exposure to these drugs is one of the factors that makes problems with dry eye, and other ocular issues far more common in lupus patients. There are three groups of medication that are typically prescribed for people who have been diagnosed with this disease, and these are:

  • antimalarials such as planquenil and hydroxychloroquine
  • steroids
  • immunosuppressive drugs such as mycophenolate and methotrexate

All of these different types of drugs have been scientifically linked to adverse results with the eye, including swelling, inflammation, blood vessel problems, and of course, dry eye syndrome. At the same time, immunosuppressive drugs that are used frequently in the treatment of lupus can increase a patient’s chances of suffering from other eye related problems, such as infections like conjunctivitis.

According to some doctors and health experts, the antimalarial drugs that are used for people with lupus are some of the safest medications available. However, in very rare situations, some patients with lupus who have been exposed to antimalarials have suffered from damage to the retina as a side effect. However, it is worth noting that retinal problems that these drugs cause are usually only noticed when particularly high doses are used. In other words, doctors may be able to avoid such side effects by limiting the amount of medication given to a patient in any one period of time.

Finally, in patients with lupus, steroids are typically administered either in pill form or intravenously. In some specific cases, when inflammation of the eye is already present, steroids can be given as topical drops. Unfortunately, any of the methods used for taking steroids can increase a person’s chances of suffering from eye-related problems such as cataracts and glaucoma.

Resources and References:

Ocular manifestations of systemic lupus erythematosus – Information about lupus and ocular diseases or conditions. (Rheumatology, Oxford Journals)
Eye Problems in Lupus – General information about the common eye problems typically associated with lupus. (Hospital for Special Surgery)
When Autoimmune Disease Initiates DRY EYE – Information about dry eye and autoimmune diseases. (Review of Optometry)
Sjogren’s Syndrome – Information about Sjogren’s syndrome. (MedicineNet.com)