Ocular lesions in systemic lupus erythematosus: An overview
Keywords:
Systemic lupus erythematosus, SLE, ocular lesions, manifestations, retinopathyAbstract
Systemic lupus erythematosus (SLE) is a life-threatening, multisystemic, chronic autoimmune disease. Ocular manifestations of SLE are diverse, affecting any part of the eye. It is a potentially blinding disease with ocular manifestations as the presenting feature. The prevalence of retinal involvement is estimated to be 3% to 29% and it tends to be bilateral and asymmetrical. Retinal signs often concur with the severity of systemic inflammation. Microangiopathy in SLE mimics diabetic and hypertensive retinopathy, moderately severe SLE can have presentation that mimic Purtscher-like retinopathy with a prevalence of 0.14%. Vaso-occlusive disease can either have isolated/combined, retinal artery or vein occlusion. Associated antiphospholipid antibody also increases the risk of vaso-occlusion. The occurrence of optic neuritis and ischemic optic neuropathy is rare in SLE. Presence of peripheral ulcerative keratitis, and scleral, orbital, retinal, choroidal, and neurological manifestations require immediate systemic therapy. Hydroxychloroquine >6.5 mg/kg for 5 years is associated with high risk of toxicity. Modern imaging techniques like fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) help in diagnosis and monitoring of disease activity.
References
Papagiannuli E, Rhodes B, Wallace GR, Gordon C, Murray PI, Denniston AK. Systemic lupus erythematosus: an update for ophthalmologists. Survey of ophthalmology. 2016 Jan 1;61(1):65-82.
Fanouriakis A, Tziolos N, Bertsias G, Boumpas DT. Update οn the diagnosis and management of systemic lupus erythematosus. Annals of the rheumatic diseases. 2021 Jan 1;80(1):14-25.
Karpik AG, Schwartz MM, Dickey LE, Streeten BW, Roberts JL. Ocular immune reactants in patients dying with systemic lupus erythematosus. Clinical immunology and immunopathology. 1985 Jun 1;35(3):295-312.
Sivaraj RR, Durrani OM, Denniston AK, Murray PI, Gordon C. Ocular manifestations of systemic lupus erythematosus. Rheumatology. 2007 Dec 1;46(12):1757-62.
Gergianaki I, Fanouriakis A, Repa A, Tzanakakis M, Adamichou C, Pompieri A, et al. Epidemiology and burden of systemic lupus erythematosus in a Southern European population: data from the community-based lupus registry of Crete, Greece. Annals of the rheumatic diseases. 2017 Dec 1;76(12):1992-2000.
Cho H. Ocular manifestations of systemic lupus erythematosus. Hanyang Medical Reviews. 2016 Aug 1;36(3):155-60.
Sobrin L, Foster CS. Systemic lupus erythematosus choroidopathy. BMJ. 1994
Wu C, Dai R, Dong F, Wang Q. Purtscher-like retinopathy in systemic lupus erythematosus. American Journal of Ophthalmology. 2014 Dec 1;158(6):1335-41.
Shah DN, Singh D. Role of lupus retinopathy in systemic lupus erythematosus. Journal of ophthalmic inflammation and infection. 2016 Dec;6(1):1-4.
Yap EY, Fam HB, Leong KP, Buettner H. Nocardia choroidal abscess in a patient with systemic lupus erythematosus. Australian and New Zealand Journal of Ophthalmology. 1998 Nov;26(4):337-8.
Wang JC, Chuah GC, Yap EY. Tuberculous choroidal granulomas in a patient with systemic lupus erythematosus. International Ophthalmology. 2001 Mar;24(2):107-9.
Donders RC, Kappelle LJ, Derksen RH, Algra A, Horbach DA, de Groot PG, et al. Transient monocular blindness and antiphospholipid antibodies in systemic lupus erythematosus. Neurology. 1998 Aug 1;51(2):535-40.
DelGiudice GC, Scher CA, Athreya BH, Diamond GR. Pseudotumor cerebri and childhood systemic lupus erythematosus. The Journal of Rheumatology. 1986 Aug 1;13(4):748-52.
Carlow TJ, Glaser JS. Pseudotumor cerebri syndrome in systemic lupus erythematosus. Jama. 1974 Apr 8;228(2):197-200.
Bashiri H, Karimi N, Mostafaei S, Baghdadi A, Nejadhosseinian M, Faezi ST. Retinopathy in newly-diagnosed systemic lupus erythematosus: should we screen for ocular involvement?. BMC rheumatology. 2021 Dec;5(1):1-6.
Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016 Jun 1;123(6):1386-94.
Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016 Jun 1;123(6):1386-94.
Gharbiya M, Pecci G, Baglio V, Gargiulo A, Allievi F, Balacco-Gabrieli C. Indocyanine green angiographic findings for patients with systemic lupus erythematosus nephropathy. Retina. 2006 Feb 1;26(2):159-64.
Ozturk BT, Bozkurt B, Karademir Z, Kerimoglu H. Follow-up of lupus choroidopathy with optical coherence tomography. Lupus. 2011 Oct;20(10):1076-8.
Kouprianoff S, Chiquet C, Bouillet L, Romanet JP. OCT follow-up of systemic lupus erythematosus choroidopathy. Ocular immunology and inflammation. 2010 Apr 1;18(2):113-5.
Tan EM, Cohen AS, Fries JF, Masi AT, Mcshane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1982 Nov;25(11):1271-7.
Yu C, Gershwin ME, Chang C. Diagnostic criteria for systemic lupus erythematosus: a critical review. Journal of autoimmunity. 2014 Feb 1;48:10-3.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis and rheumatism. 1997 Sep 1;40(9):1725-.
Ushiyama O, Ushiyama K, Koarada S, Tada Y, Suzuki N, Ohta A, et al. Retinal disease in patients with systemic lupus erythematosus. Annals of the rheumatic diseases. 2000 Sep 1;59(9):705-8.
Munoz-Grajales C, Gonzalez LA, Alarcon GS, Acosta-Reyes J. Gender differences in disease activity and clinical features in newly diagnosed systemic lupus erythematosus patients. Lupus. 2016 Oct;25(11):1217-23.
Yee CS, Cresswell L, Farewell V, Rahman A, Teh LS, Griffiths B, et al. Numerical scoring for the BILAG-2004 index. Rheumatology. 2010 Sep 1;49(9):1665-9.
Yee CS, Farewell V, Isenberg DA, Griffiths B, Teh LS, Bruce IN, et al. The BILAG-2004 index is sensitive to change for assessment of SLE disease activity. Rheumatology. 2009 Jun 1;48(6):691-5.
Palejwala NV, Walia HS, Yeh S. Ocular manifestations of systemic lupus erythematosus: a review of the literature. Autoimmune Diseases. 2012 Jan 1;2012.
Petri M. Cyclophosphamide: new approaches for systemic lupus erythematosus. Lupus. 2004 May;13(5):366-71.
Condon MB, Ashby D, Pepper RJ, Cook HT, Levy JB, Griffith M, et al. Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Annals of the rheumatic diseases. 2013 Aug 1;72(8):1280-6.
Soforo E, Baumgartner M, Francis L, Allam F, Phillips PE, Perl A. Induction of systemic lupus erythematosus with tumor necrosis factor blockers. The Journal of Rheumatology. 2010 Jan 1;37(1):204-5.
Hanane M, Mounir B, Rachid Z, Karim R, Abdelber O. Severe ischemic retinopathy in a patient with systemic lupus erythematosus without antiphospholipid syndrome: a case report. Saudi Journal of Ophthalmology. 2015 Apr 1;29(2):169-71.
