How Lupus May Affect Your Eyes and Eyesight

One of the most common symptoms of lupus is a butterfly-shaped rash across your cheeks and the bridge of your nose called a malar rash. It occurs in about half of people with lupus and often appears after sun exposure. It can last for days to weeks before fading.

Malar rash can precede other lupus symptoms by months or years.

Can lupus cause a purple rash around your eyes?

A malar rash can be red in people with a lighter skin tone, or purple in people with a darker skin tone. Many people mistake a malar rash for a sunburn.

Discoid lupus effects on your eyes

Discoid lupus is the most common type of lupus that affects your skin. Other body organs are not affected with discoid lupus. It causes dry red or purple patches that may leave discolored scars or hair loss on your scalp. In about 80% of cases, it causes symptoms only above the neck.

Discoid lupus can cause patches to form on the skin around your eyelids that may be confused with chronic blepharitis.

In a 2021 review of studies, researchers found that 16% of more than 18,000 people with lupus had dry eyes. The researchers also found 12% of people met the criteria for secondary Sjögren’s syndrome.

Sjögren’s syndrome is an autoimmune condition that reduces the amount of moisture produced by your mouth and eyes. It’s called secondary Sjögren’s syndrome when you also have another type of autoimmune condition like lupus or rheumatoid arthritis.

Studies suggest that slightly less than 1% of people with lupus have uveitis, or inflammation of the middle layer of the eye that includes the:

• iris
• choroid
• ciliary body

Symptoms of uveitis include:

• eye redness
• eye swelling or puffiness
• eye pain
• light sensitivity
• blurred vision
• decreased vision
• floaters

Your conjunctiva is the clear membrane that covers the inside of your eyelids and your eye whites. Inflammation of this layer is called conjunctivitis or pink eye.

In a 2020 study from Taiwan, researchers found about half of 521 people with lupus had chronic conjunctivitis not caused by allergies, compared with about 30% of people without lupus.

Symptoms can include:

• pink or red eyes
• pain and discomfort
• eye swelling
• increased tear production
• feeling like something is in your eye
• discharge
• crusting on your eyelids or lashes
• itchiness or burning
• light sensitivity

People with lupus can develop retinal disease that ranges from mild to blinding. Your retina is a layer of cells at the back of your eye that converts light into electrical signals. The retina is affected in about 10% of people with lupus.

According to the Lupus Foundation of America, changes to the blood vessels of the retina are the most common form of eye involvement in people with lupus. These changes most commonly include:

• retinal hemorrhages (bleeding)
• cotton wool spots (abnormal spots seen in an eye exam)
• vascular tortuosity (abnormal curvature of blood vessels)

Other signs and symptoms can include:

• retinal hard exudates (abnormal buildups of fats and proteins)
• retinal vasculitis (inflammation of blood vessels)
• retinal occlusion (blood vessel blockage)

Scleritis occurs in about 1% of people with lupus and can be the first sign of disease. Scleritis is inflammation of your eye white, also called the sclera. It can cause a yellow or blue discoloration of your eye white, although it might present as other colors as well.

Scleritis can also cause:

• blurred vision
• eye pain or tenderness
• redness
• watery eyes
• light sensitivity

Lupus and some lupus medications can also cause hepatitis, which can lead to jaundice. Jaundice is the yellowing of your eyes and skin.

The optic nerve is affected in about 1% of people with lupus. Inflammation of your optic nerve can cause:

• vision loss
• pain
• flashing color
• loss of color vision
• loss in parts of your vision

Damage to the nerves that control the muscles that move your eyes occurs in up to 29% of people with lupus. This damage can cause problems with eye movement.

Some medications used to treat lupus symptoms can affect your eyes. The drug hydroxychloroquine, sold under the name Plaquenil, can cause toxicity to your retina especially if you’re taking high doses. Steroids and some other immunosuppressants are also known to affect your eyes.

Many of the complications of lupus can lead to light sensitivity, such as:

• scleritis
• uveitis
• conjunctivitis

Light sensitivity can also be a side effect of medications used to treat lupus.

Lupus is treated with medications to reduce your immune system activity or reduce inflammation. They include:

• antimalarial medications like hydroxychloroquine
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• corticosteroids
• immunosuppressive drugs
• biologics

Other treatments may be prescribed or recommended for specific eye symptoms, such as:

Learn more about treating lupus.

The American Optometric Association recommends eye exams every 2 years for adults ages 18 to 64 and every year for adults over the age of 65. They recommend annual eye exams for people with active health concerns who are at an elevated risk of ocular complications, such as people with lupus. People taking the drug Plaquenil should get a baseline eye exam when they start taking the drug.

It’s also important to see an eye doctor anytime you notice any changes in your vision, especially if you’ve previously received a diagnosis of lupus.

Lupus and medications used to treat lupus can affect your eyes in many ways, such as causing vision changes, rashes around your eyes, or inflammation in your eyes.