Lupus (Systemic Lupus Erythematosus) Treatment of the Retina
This photograph is from the National Eye Institute, courtesy of NEI staff clinician H. Nida Sen, M.D., M.H.Sc., clinical fellow Chloe Gottlieb, M.D., F.R.C.S.C., and ophthalmic imaging specialist Michael Bono, B.A., C.R.A., C.O.T.
Systemic lupus erythematosus (SLE) is a disease that is commonly referred to as Lupus. It is an autoimmune disease where the bodies immune system malfunctions and attacks its own cells and tissues. It can attack almost any organ in the body with the skin, kidneys, heart, lungs, blood vessels, joints, and brain common targets. A common mnemonic or rhyme used in the past to describe Lupus was “hocus pocus out of focus systematic erythematosus.” That sums up the difficulty in diagnosing a disease that can effect almost any organ in the body. More common in middle aged women, Lupus can be treated with a variety of medications.
The eye has complications from Lupus in about 1 of every 5 patients. Occasionally eye problems may be the first signs of Lupus. The eyelids may lose lashes and swell on top where the lacrimal gland that secretes tears is located. Dry eyes from damage to the lacrimal gland can lead to complications on the cornea, the clear tissue on the front of the eye. Inflammation of the sclera (the white tissue of the eye) or uveitis (inflammation inside the eye) may occur.
The immune system can form deposits in the blood vessels in the back of the eye blocking the blood flow and causing damage to the retina, the tissue we see with that lines the back of the eye. The damage occurs from the oxygen deprivation that happens when the blood flow is restricted. The lack of oxygen causes the eye to produce a protein called vascular endothelial growth factor that causes neovascularization, or the growth of fragile new blood vessels. These blood vessels rupture and bleed, resulting in vision loss.
In the photograph you can see a central round white circle where the optic nerve enters the back of the eye. The red branching lines are the normal blood vessels that supply the retina. There are numerous small white spots, some with black centers. These are areas where the retinal tissue has been destroyed by treatment with multiple laser burns. Since they are all off of the central line of sight there is no noticeable loss of sight from this treatment. They do reduce the amount of tissue and therefore the overall demand for oxygen. The patient also received an eye injection of a drug that blocks the production of the vascular endothelial growth factor. The final result was to stop the growth of the fragile blood vessels and prevent the loss of vision. There is a V shaped white area that is where the blood vessels had been proliferating and now it has become scar tissue.
Lupus is a complex disease that requires careful treatment, and even the medications used in treating the disease need to be monitored as they can cause eye problems by themselves.