Ophthalmologic manifestations of systemic lupus erythematosus: the effect of autoimmune inflammation

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease of unknown etiology with heterogeneous clinical manifestations. One third of patients with SLE have various ophthalmologic symptoms. Eye lesions may be the initial signs of SLE and lead to severe complications, including vision loss. Ophthalmologic manifestations are often associated with the degree of activity of systemic inflammation. Dry keratoconjunctivitis, or secondary Sjogren's syndrome, is the most common ophthalmologic manifestation of SLE. Episcleritis and scleritis are less common, but they can be the first signs of SLE. Unilateral or more often bilateral retinopathy associated with retinal vasculitis can cause visual loss of varying severity. A number of adverse ophthalmologic events occur on the background of long-term use of drugs used currently for the treatment of SLE: posterior subcapsular cataract and secondary open-angle glaucoma when using glucocorticosteroids, retinopathies – in cases of long-term use of hydroxychloroquine. The side effects of other immunosuppressive and biological agents are still poorly understood. Regular ophthalmologic examinations are recommended for all patients with SLE.