Retinal Vasculitis, Nerve Damage and Lupus

Over 28% of people with lupus have eye symptoms, an issue that is not often discussed. The causes can be in the eye, the optic nerve, and the brain, but all are caused by inflammation. 

Often, the eye is not directly affected by lupus. This is because the eye is actually protected from the immune system, like the brain and reproductive organs. For the most part, eye issues in lupus are caused by constricted or damaged blood vessels, but can also involve damage to the optic nerve or the skin tissues near the eye can also cause vision loss. Lupus-caused vasculitis might be responsible for other comorbidities of lupus as well. You can read more about it here. However, sometimes lupus can be severe enough to directly damage the retina or cornea.

Eye Damage and Lupus

1/3 of people with lupus have eye-related symptoms, particularly in the cornea and retina. The cornea is the outside layer of the eye that protects it from dirt, germs, UV light, and other things from the outside world. This often shows up as keratitis, where the cornea is inflamed and causes red eye, pain, excessive tears, light sensitivity, and decreased or blurred vision. Keratosis can be treated, and reducing systemic lupus erythematosus (SLE) symptoms will also help prevent keratitis.

The retina is the layer of tissue at the back of the eye that receives light and turns it into neural impulses that are sent to the brain. Retinopathy was found in 10% of patients with lupus in a small cross-sectional study on 69 patients with SLE. Usually, the symptoms take the form of vasculitis, but lupus inflammation can also cause retinal detachment. Infections are also a possible cause of lupus-based vision loss, as the bacteria slip by the malfunctioning immune system and colonize the eye.

Early recognition by an ophthalmologist is key to avoiding vision loss. Unfortunately, steroid medications are key to treating lupus, and can induced glaucoma, cataracts, and chorioretinopathy. Other “gold standard medications” such as antimalarial medications including Hydroxychloroquine (Plaquenil,) Chloroquine (Aralen) and Quinicrine (Atabrine) which the immune system to regulate itself better. They are very effective at treating lupus, and do not cause vulnerability to infection as immunosuppressants do. However, a known side effect is retinal damage. So, for people with eye problems and lupus, it is important to find alternative medications.

Retinal Vasculitis and Lupus

Retinal vasculitis involves the retina being cut off from the blood supply. Vasculitis is the term for the inflammation of blood vessels and is a common symptom of lupus. When blood vessels become inflamed, they can narrow or swell, restricting or even blocking blood flow. However, it can also weaken the walls of the blood vessel, allowing it to stretch and bulge. If the walls of this bulge break, then it becomes an aneurysm and leads to potentially life-threatening bleeding. This is different from clots and atherosclerosis, but it can contribute to clots that are already there.

The result, retinopathy is a “catch-all” term for a variety of eye-related symptoms, usually painless. You can read more about it here. Vasculitis in the eye isn’t usually enough to kill the cells in the retina, but when the body tries to ‘fix’ the issue, the new blood vessels it creates can block vision due to poor placement. They can also end up bleeding into the eye. If these blood vessels affect the central area of the retina, called the macula, this can cause blindness. 

Neuromyelitis Optica and Lupus

Neuromyelitis optica, also known as Devic’s disease, is autoimmune disease inflammation that attacks the optic nerves and spinal cord. Neuromyelitis optica (also known as NMO,) can occur alongside SLE as a part of the autoimmune disease and causes issues with vision and even blindness.

Nerve damage is a potential complication of lupus and can directly affect the optic nerve or the nerves controlling the muscles attached to the eye. This is most likely to happen alongside other nervous system symptoms. Hearing loss can also occur happen for the same reasons. 

NMO and SLE can both be treated with high-dose oral and intravenous corticosteroids, intravenous immunoglobulin, mycophenolate mofetil, tacrolimus, low-dose daily oral cyclophosphamide and rituximab.

Treating Vision Loss and Lupus

In case studies early recognition and interventions seemed to be key. Treating lupus also treated retinopathy, although antimalarials such as hydroxychloroquine are to be avoided. 

Retinopathy is treatable with anti-coagulant medications, which help reduce blockages. Laser surgery can correct other types of retina-based disorders, using the highly energetic light to break up clots or seal off blood vessels in bad placements. It is also treated with corticosteroids, bevacizumab, rituximab, and belimumab – the typical treatment for reducing inflammation for this autoimmune disease.

One of the few types of medications that do not affect the eye are steroids, which can be given as eye drops to soothe inflammation when it directly affects the eye.