Dry Eye and Lupus

Dry eye is a frustrating and painful condition that affect the eyes of over 1/3 of people with lupus.

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects organs throughout the body. The eye is usually an “immune-privileged” organ, which means that it is safe from the immune system and highly resistant to inflammation. However, autoimmune disease can overwhelm this resistance and attack various parts of the eye.

Eyes require constant lubrication to function, generally by producing a liquid known as “tears.” Tears are produced by Lacrimal glands above the eye. Blinking spreads these tears across the eye and moves old tears into the corner of the eye, where it either drains down the face, or into the nasal passage. When SLE damages the tear ducts or tear glands, it can lead to a condition called dry eye. The damaged tear glands either don’t produce enough tears, or, alternatively, produce tears that don’t properly lubricate or clean the eye.

Dry eye is, as the name describes, an uncomfortable dryness of the eyes, resulting in a stinging, burning, scratchy sensation in the eyes, and the constant feeling that there is something in ones eyes.

Other symptoms of dry eye include:

• Mucous around the eyes
• Watery eyes and blurred vision
• Eye fatigue and poor night vision

It should be noted that dry eye is not just uncomfortable. It can damage the eye and also make eye infections more likely.

Doctors can use the Schirmer test as a way to diagnose dry eyes, especially in milder or early cases. A small strip of sterile paper is placed under the eyelid. The paper is removed after 5 minutes and the wetness of the paper is measured – if less than 5mm of the paper is wet, then this is abnormal and there is decreased tear production.

Dry Eye and Sjogren’s Syndrome

As many as 1/3 of people with lupus also have dry eye syndrome. Some of these patients may also have Sjogren’s Syndrome.  Sjogren’s syndrome is an autoimmune disease that sometimes happens alongside lupus, which attacks the salivary glands in the mouth and the lacrimal glands in the eye, causing dry mouth and dry eyes. The damage is permanent, but it can be controlled with lifestyle changes and medication.

Dry eye can also occur independently and completely due to SLE. This was confirmed by an analysis of 49 SLE patients who did not have anti-Sjogren’s syndrome antibodies and had no dry mouth symptoms. All of the patients had dry eye and lupus involvement, but no evidence of Sjogren’s syndrome.

Diagnosing and Treating Dry Eye

The environmental conditions can effect the eyes of people with lupus, such as dryness, humidity, and light levels. Cold weather in particular can cause dryness in the eyes, and make dry eye worse.

Dry eye can be treated by also treating lupus, which stops the body from damaging the tear ducts further and enables these important organs to heal. However, dry eye can also be treated by:

• Avoiding dry air sources like hair dryers, heaters, air conditioners, and fans.
• Use humidifiers to add moisture to the air, which can prevent the eyes from drying out too fast.
• Limit computer time, as blue light from screens can make eyestrain worse.
• Artificial tears can be used to keep the eyes moist and clean.