Lupus Retinopathy and Diagnosis

Retinopathy, damage to the retina, is one of the key early potential symptoms that point to a diagnosis of lupus.

With a lupus diagnosis, the earlier the better, and the eye-related symptoms of lupus can be a key warning sign that other symptoms are on the way. Eye involvement and damage area common symptom of systemic lupus erythematosus (SLE,) effecting approximately 1/3 (15%) of people with lupus according to studies.

Retinopathy is a catch-all term for damage to blood cells in the retina, the part of the eye that senses light, that is caused by a disease. The symptoms can include blurred vision, spots, light flashes, distortion, poor color vision, blind spots, and difficulty seeing fine details. These are typically painless, though if the optic nerve is inflamed and damaged, a condition known as papillitis, it can hurt quite a bit. Many different diseases can cause retinopathy, and it can vary in how fast it happens and whether it leads to permanent eye damage or blindness.

Diagnosing Retinopathy

With retinopathy, the eye doesn’t look different. Actually, diagnosing retinopathy requires a person to go to an experienced eye doctor, also known as an opthamologist. They use a light called an ophthalmoscope and magnifier to examine the inside of the eye. Looking for ruptured blood vessels, swelling in the retina or optic nerves, and bubbles of fluid in the retinal layers. The specific things they  look for are called “cotton-wool spots,” which are fuzzy-looking distortions, clots, damage, or even bleeding in the blood vessels of the retina.

Retinopathy itself occurs in roughly 15.8% of patients, according to studies.  When someone has other early indicators of lupus, such as fatigue, headaches, or a malar rash, retinopathy can send a doctor-in-the-know down the path to diagnosing lupus.

Lupus and Retinopathy

Systemic lupus is an autoimmune disease that causes inflammation and damage in organs throughout the body. This includes the eye. Lupus can inflame the optic nerve. But it can also damage blood vessels in the delicate, light-sensing tissue of the retina. Retinopathy caused by SLE can be severe, and even cause blindness. Lupus can also lead to “dry eye,” and while this does not directly effect the retina, dry, itchy eyes and improperly developed tears can irritate and damage other parts of the eye and make retinopathy worse.

However, if SLE is controlled with corticosteroids and other lupus medications, the retina can have a chance to heal, and some vision could recover. When caught early and treated, most patients with lupus and mild retinopathy have a low risk for vision loss.

Catching retinopathy early and screening for lupus is especially important for children with lupus. Early screening can also catch other symptoms, such as fatigue, neurological (brain and nervous system) involvement and renal (kidney) symptoms. These can be potentially devastating but catching them early allows them to be controlled. And even prevented from developing into something more severe.

Treating Lupus Retinopathy

Lupus medications can help reduce inflammation in the body, which can help with the retinopathy symptoms. Something to note – two common medications taken to alleviate lupus symptoms can cause reactions that cause or exacerbate retinopathy:

Salicylates such as aspirin and quinine, an older antimalarial drug, might not be recommended for people with retinopathy and lupus. Hydroxychloroquine, another common lupus medication, can also cause eye-related symptoms.

Anticoagulants can improve blood flow in the retina.

Inflammation in the blood vessels is a common symptom of lupus, leading to hypertension and high blood pressure. This means that, frequently, anticoagulants and other blood thinners are often prescribed to reduce and control heart disease and stroke risk. Anticoagulants will also help with retinopathy. 

A treatment called photocoagulation can be used to force blood vessels to rebuild capillaries in areas of the eye where they were too damaged to function. This allows the body to better ‘feed’ the retina, encouraging both healing and proper function.