Lupus and Your Eyes

Medically Reviewed by Melinda Ratini, MS, DO on March 04, 2022
5 min read

Lupus can affect any part of your body, including your eyes. The condition can bring on problems that make your vision worse without treatment. It’s linked to dry eyes, too. What’s more, certain medications for lupus can also trigger eye issues.

But if you work closely with your rheumatologist (a doctor who specializes in treating lupus) and an ophthalmologist (eye doctor), you can lower your risk or keep these problems from getting worse. Here are some lupus-related eye conditions to be aware of, along with their symptoms and treatments.

It’s very common for your eyes to be dry when you’re living with lupus.

Some people have secondary Sjögren’s syndrome. That’s a condition that affects tear glands. It’s secondary because it happens in addition to lupus rather than on its own. Like lupus, it’s an autoimmune disorder, meaning your immune system attacks healthy cells by mistake.

In secondary Sjögren’s syndrome, an immune system attack damages the glands that make tears in your eyes and saliva in your mouth. Your body stops making enough tears to lubricate and nourish your eyes.

Dry eye can bring on these symptoms:

  • Irritated, gritty, scratchy, or burning eyes
  • Feeling like there’s something in your eyes
  • Eyes that water too much
  • Blurry vision

You can treat dry eyes with over-the-counter artificial tears -- a liquid, gel, or ointment that helps ease the symptoms. Humidifiers and eye shields might help, too. If your symptoms are severe, your eye doctor might recommend a prescription drug or surgery.

Without treatment, dry eyes could damage your cornea, or the surface of your eyes. It could also worsen your vision.

It’s a common eye problem in people with lupus, and it can cause vision loss that ranges from mild to severe.

Retinal vasculitis limits blood flow to the retina, a layer of light-sensing cells at the back of your eye. When your retina tries to repair itself, new blood vessels can form and weaken your vision. The blood vessels could also bleed, which can impact your ability to see.

Retinal vasculitis can also affect the nerves that help control eye muscles. This may cause irregular eye movement that leads to double vision.

Your doctor might treat retinal vasculitis with steroid drugs called glucocorticoids. They may also prescribe immunosuppressants, drugs that curb your immune system. This allows the doctor to give you a lower dose of steroids, which may mean fewer side effects.

About 1% of people with lupus get scleritis, a condition caused by inflammation in the sclera, the white outer part of the eye.

It can bring on symptoms like:

  • Pain
  • Tenderness
  • Redness and swelling of the sclera
  • Blurry vision
  • Tearing

Light might also hurt your eyes. It’s also possible to have pain in your jaw, face, or head. Some people with scleritis lose some or all of their vision. It’s important to get treatment as soon as possible to lessen the chance of this happening.

Treatment depends on how severe your scleritis is, and options include:

  • Steroid pills
  • NSAID drugs
  • Eye solutions or antibiotics
  • Medication that lowers your immune system (for severe scleritis)
  • Surgery (also for severe cases)

Taking charge of your lupus can also help control scleritis symptoms, so work closely with your doctor.

Yes, but it’s not common.

Lupus can lead to palsy (meaning partial or complete weakness or paralysis) in nerves in your brain called cranial nerves. Some of these nerves allow you to move your eyes, blink, and see. Certain cranial nerve palsies due to lupus can bring on eye symptoms like:

  • Double vision
  • Worse eye movement and alignment
  • Poor pupil reflexes
  • Drooping eyelids

Your eye doctor may wait to see if your palsy gets better on its own within 6 months. If you have double vision, they may try to treat it with prism glasses or by having you wear a patch over one eye. If the palsy doesn’t improve after 6 months, they may recommend eye muscle surgery to help your eyes align properly or to improve double vision.

Rarely, lupus damages a cranial nerve called the optic nerve. That’s the nerve in the back of your eye that sends light signals to your brain. This is called optic neuritis, and it can bring on symptoms like:

  • Blurry or dim vision
  • Colors that look dull or faded
  • Pain in the back of your eye socket
  • Pain when moving your eyes

Steroids are the most common treatment for optic neuritis.

The term “lupus” usually refers to systemic lupus, which is the most common type of the disease. But there are four main types. One of them is called cutaneous lupus, and it only affects the skin. There are a few kinds of cutaneous lupus. One form called discoid lupus brings on rashes. These rashes affect the skin around the eyelids in about 5% to 6% of people with discoid lupus.

The rash usually doesn’t hurt, but it may burn or itch. It tends to look:

  • Well-defined
  • Slightly raised
  • Scaly
  • Misshapen

Discoid lupus could cause someone to lose their eyelashes. It can also bring on scarring that affects the edge of the eyelids.

Your doctor may treat these eyelid rashes by prescribing the medicine hydroxychloroquine, which you take by mouth, and steroids that you rub gently on your skin. Usually you have to stay out of the sun and protect yourself from its rays while you’re getting treatment.

Some meds used to treat lupus can have eye-related side effects. Experts say one drug in particular, hydroxychloroquine (Plaquenil), can damage the retina over time, especially if you take high doses. This side effect is rare, but it can lead to vision loss.

To lower the chances of that happening, everyone with lupus should get an eye exam once a year, especially if you take hydroxychloroquine. To play it extra safe, get a baseline eye exam before or shortly after you start taking this drug, and get a checkup from an eye doctor every year.

Immunosuppressive drugs that turn down your immune system (like methotrexate and mycophenolate) can make you more likely to get eye infections. Your doctor can treat infections with antibiotics.

Steroids, which can help ease lupus pain and inflammation, can also raise your risk for glaucoma and cataracts. There are treatments for both conditions.

You should see your rheumatologist and ophthalmologist whenever you have vision trouble. That way, the doctor can find out ASAP if it’s due to lupus, lupus treatments, or just aging.