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Autoimmune diseases occur when the immune system, which typically protects the body from harmful pathogens, gets out of control and mistakenly attacks the body’s tissues. These diseases can affect various organs, including the eyes, leading to ocular symptoms and complications. Women are 80% more likely to have autoimmune diseases than men. The reason for this is not fully understood; however, it has been noted that pregnancy can trigger autoimmune diseases, and some preexisting autoimmune diseases have been known to improve during pregnancy. An important relationship to understand is the relationship between autoimmune diseases and the eyes which is crucial for accurate diagnosis and effective management, especially when the cause of the symptoms is uncertain. There are several types of autoimmune diseases and their effects on the eyes.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is a chronic inflammatory disorder that primarily affects the joints and can result in disability. It commonly affects the eyes, leading to conditions such as dry eye syndrome (keratoconjunctivitis sicca) and scleritis (inflammation of the sclera). Less frequently, it can cause episcleritis, uveitis, and peripheral ulcerative keratitis. Symptoms may include redness, pain, sensitivity to light, and diminished vision. Treatment typically involves using lubricating eye drops for dryness, corticosteroids for inflammation, and immunosuppressive medications to manage the underlying autoimmune response, which can be prescribed by your general practitioner.
Systemic Lupus Erythematosus (SLE)
SLE commonly affects women of childbearing age and multiple organs of the body. Ocular manifestations may include dry eye, retinopathy, optic neuritis, episcleritis, and scleritis. Patients may experience symptoms such as eye pain, visual disturbances, and dryness. Treatment involves managing the systemic disease with immunosuppressants, and corticosteroids, and applying topical treatments to relieve ocular symptoms.
Sjogren’s Syndrome
Sjogren’s syndrome is a disorder where the body’s immune system attacks the glands that produce moisture in the mouth, eyes, skin, and respiratory tract. This leads to severe dry eyes (keratoconjunctivitis sicca) because of lymphocytic infiltration of the lacrimal glands. Common symptoms include persistent dryness, a burning sensation, and a gritty feeling in the eyes. Treatment involves using artificial tears, punctual plugs to help retain moisture, and immunomodulatory drugs to decrease inflammation in the glands.
Graves’ Disease
Graves’ disease occurs when the thyroid gland is overactive, ocular manifestation of this autoimmune disorder affects the thyroid causing thyroid eye disease (Graves’ orbitopathy). This condition leads to proptosis (bulging eyes), diplopia (double vision), and exposure keratopathy. Symptoms include eye bulging out of the socket, redness, swelling, pain, and vision changes. Treatments range from artificial tears and corticosteroids to surgical interventions in severe cases to relieve pressure and correct eye alignment.
Multiple Sclerosis (MS)
Multiple sclerosis (MS) is a long-term condition that affects the central nervous system, leading to potential damage to the brain, optic nerve (responsible for vision), and spinal cord. Ocular manifestations of MS can include optic neuritis (inflammation of the optic nerve) and double vision due to the involvement of the eye movement nerves. Common symptoms include sudden vision loss, eye pain with movement, and double vision. Treatment involves high-dose corticosteroids to reduce inflammation, along with disease-modifying therapies to help manage the overall progression of MS.
Behcet’s Disease
Behcet’s Disease is a condition that causes inflammation of the blood vessels, leading to recurrent uveitis, inflammation of the retinal vessels, and retinal vein occlusion. Symptoms include eye pain, redness, blurred vision, and light sensitivity. Treatment involves using corticosteroids and immunosuppressive agents to control inflammation and prevent recurrent episodes.
Autoimmune diseases are conditions that typically have no cure and are often rare and difficult to diagnose, which can result in patients going years before receiving a proper diagnosis. These diseases can cause various eye problems such as discomfort, double vision, vision impairment, and even blindness if not managed correctly. Early and proper diagnosis and treatment of eye symptoms are crucial to avoid serious complications. Accurate diagnosis and comprehensive care often require a multidisciplinary approach involving rheumatologists, optometrists, ophthalmologists, and other specialists. Understanding the connection between autoimmune diseases and eye health can help patients and healthcare providers work together to preserve vision and enhance overall quality of life.
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Feature Image by Sora Shimazaki for Pexles
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