Dry eye syndrome is common in people with lupus because of the effects of lupus on the tissues involved in tear production. Symptoms can include stinging, burning, or feeling like something is in your eye.
Lupus is an autoimmune disease that causes inflammation in your body. Some commonly affected areas include the joints, skin, and internal organs such as the heart and kidneys.
It’s also possible for lupus to affect the eyes. In some people, this can lead to dry eye syndrome.
This article examines how lupus affects the eyes. We review symptoms of dry eye syndrome to be aware of, along with diagnosis and treatment.
Lupus causes increases in inflammation in your body, including in and around the tissues of your eye. When this happens, you can experience a variety of eye symptoms.
It’s estimated that as many as one-third of people with lupus have eye symptoms. The level of these symptoms can range from mild to severe.
Severe eye symptoms because of lupus can threaten your vision. However, it’s important to be aware of any type of eye symptom related to lupus. This is because eye symptoms can be an
Drugs that are used to treat lupus, particularly hydroxychloroquine (Plaquenil), can also cause eye problems. Hydroxychloroquine dampens your immune response, helping to reduce inflammation. However, when it’s prescribed in high doses for months or years, hydroxychloroquine may also damage your retina.
Dry eyes are a pretty common symptom of lupus. A
Tears are vital for keeping your eyes moist and lubricated. There are a few components to tears. What we normally think of as tears is the watery part that’s expressed by the tiny lacrimal glands within the conjunctiva (the mucous membrane that covers the front of the eyeball and inner eyelids).
Tears also have an outer oily layer that keeps the tear film from evaporating. The oil is expressed by the meibomian glands, situated deep within the eyelids and expressed along the eyelid margins.
Lastly, goblet cells in the conjunctiva express mucus that helps evenly distribute the tear film over the ocular surface.
Lupus and dry eyes
When the eyes and surrounding tissues are overwhelmed by inflammation because of lupus, it can negatively affect tear production and lead to dry eyes, eye discomfort, and blurry vision.
For example, the lacrimal glands may not make enough tears or the meibomian glands may not make enough oil, meaning tears evaporate more quickly.
The effects of lupus can extend to many parts of the eye, including those involved in tear production.
Lupus and Sjögren’s disease
Lupus is also linked to another autoimmune disease called Sjögren’s disease. In Sjögren’s disease, your immune system selectively attacks your lacrimal and salivary glands. As such, the main symptoms of SS are dry eyes and dry mouth.
When you have Sjögren’s disease that’s associated with lupus, it’s called secondary Sjögren’s disease. Systematic reviews and research have estimated that
Secondary Sjögren’s disease may lead to dry eye syndrome in some people with lupus. However, it’s also important to know that dry eyes
The symptoms of dry eye syndrome can include:
- stinging or burning sensations in your eye
- a sandy or gritty feeling, like something is in your eye
- red eyes
- blurry vision
- tired eyes
- sensitivity to light
- pain when wearing contact lenses
- increased tearing
It may seem counterintuitive that dry eye syndrome causes tearing. However, increased tearing is your body’s response to the irritation caused by eyes that are too dry.
In this situation, the source of excessive, reactive tearing is the larger lacrimal glands located just above each eyeball within the bony orbit (eye socket).
Generally speaking, dry eye syndrome is a chronic, or long lasting, condition. Its symptoms can be made worse by factors that contribute to dry eyes. These can include things such as :
- dry air
- exposure to wind, smoke, or pollution
- long periods of reading or screen time at a computer, tablet, or phone
If you’re having persistent dry eye symptoms, make an appointment with an eye doctor. They can help to determine what may be causing them.
If you have lupus and think that you have dry eye syndrome, an eye doctor can check for dry eyes during an eye exam. During an eye exam, they’ll check your eyes and eyelids for signs of dry eye syndrome or other eye issues.
They can also do other tests to assess your tears. Examples include the tear film break-up time (TBUT) test and the Schirmer test.
The TBUT test uses a topical vegetable dye to measure the amount of time the intact tear film covers the surface of your eye after you blink. Typically, a healthy, intact tear film will persist
The Schirmer test measures how many tears you make. A small piece of paper is placed at your eyelid. You’ll be asked to close your eyes for a few minutes, after which the amount of wetness on the paper can be measured.
If a doctor or healthcare professional suspects that you may have secondary Sjögren’s disease, they can do tests to help diagnose that as well. Examples include blood tests for autoantibodies and tests to assess the activity of your salivary glands.
Keeping your overall lupus symptoms managed can lower inflammation in your body and may also reduce eye symptoms. However, if you have lupus and dry eyes, a doctor may also recommend treatments that target your eye directly.
For mild dry eyes, it’s possible that artificial tears may help to ease your symptoms. These are special types of eye drops that mimic your own tears. You can purchase these over the counter in drugstores or supermarkets.
Some people may have a reaction to the preservatives in artificial tears. In this case, a doctor may recommend preservative-free eye drops.
In more severe situations, prescription eye drops that help to lower inflammation may be used. Some examples include cyclosporine (Restasis) or lifitegrast (Xiidra).
Another potential treatment is the placement of temporary plugs in your tear ducts. These help to slow tears from draining, keeping them in your eyes for a longer period of time.
In addition to dry eye syndrome, there are also other eye problems and conditions that are associated with lupus. These include:
- lupus skin lesions around the eyelids (cutaneous lupus)
- scleritis, which is inflammation of the sclera, the white part of your eye
- anterior uveitis, which is inflammation inside the eye in a fluid-filled compartment called the anterior segment, situated between the clear cornea and the lens of the eye
- lupus retinopathy, which causes damage to your retina, the part of your eye that receives images and converts them to electrical signals to be sent to your brain
- lupus choroidopathy, which leads to damage of the area under the retina, which is called the choroid
- damage to the optic nerve, which is the nerve that sends information from your eyes to your brain
Can lupus affect your vision?
In severe situations, lupus can impact your vision. For example, untreated severe dry eye syndrome can damage the cornea, the clear layer of your eye that allows light to enter. This can lead to vision loss.
Additionally, lupus retinopathy and lupus-related damage to the optic nerve can also lead to vision loss. These eye problems are estimated to impact 10% and 1% of people with lupus, respectively.
Is there any way to prevent dry eye syndrome if you have lupus?
You can help lower the likelihood of dry eye syndrome and other eye problems by making sure that your lupus symptoms are managed. As such, always be sure to carefully stick to your treatment plan.
Other ways to prevent making dry eyes worse include:
- using a humidifier to keep the air in your home moist
- avoiding irritants such as smoke and pollution
- considering wearing wraparound sunglasses if you’re going to be outside in the wind
- being sure to take eye breaks when reading or using computers, tablets, or phones
- trying out omega-3 fatty acid supplements, which
may help improvedry eye symptoms
- drinking plenty of water to stay hydrated
Does lupus cause eye floaters?
Yes. Eye floaters are small spots or lines that appear to be floating across your vision. In lupus, noticing many new floaters may be a sign of a serious problem with your retina.
How do you know if lupus is causing eye issues?
If you have lupus, some general symptoms that can mean that it’s causing eye issues include:
- stinging, burning, or pain in your eye
- feeling like something is in your eye
- red eyes
- sensitivity to light
- increased tearing
- vision changes, which can include:
- blurry vision
Can an eye exam identify lupus?
No. An eye exam can find eye problems that are sometimes associated with lupus but not lupus itself. If you have other symptoms that are consistent with lupus, it’s important to see a doctor to help find out what’s causing them.
What are the common symptoms of lupus?
Lupus can have a variety of symptoms. According to the Lupus Foundation of America, some of the most common include:
- joint pain or swelling
- swelling in the hands, feet, or eyes
- low grade fever
- hair loss
- a butterfly-shaped facial rash
- light sensitivity, which can cause a rash to develop
- sores in the nose or mouth
- chest pain that happens when you breathe deeply
- fingers or toes that change color in response to cold or stress, which is called Raynaud’s phenomenon
Dry eye syndrome is common in people with lupus. It can happen because of the effects of lupus on the tissues involved in tear production. Some people with lupus also have secondary Sjögren’s disease, which causes dry eyes and mouth.
When dry eye symptoms are mild, artificial tears may help manage them. In more severe cases, prescription eye drops may be recommended. Overall, managing your lupus can help keep eye symptoms in check as well.
Some eye problems related to lupus can be serious and may impact your vision. Because of this, be sure to see a doctor if you have lupus and develop any new or concerning eye symptoms.