Autoimmune disorders are very common and cause systemic as well as ocular (eye) manifestations. Basically autoimmune disorder arises when our body’s own immune system abnormally destroys the substances and tissues normally present in the body. This occurs because our immune system starts considering them as a threat for the health of our body.

Autoimmune disorders & eye:

Autoimmune disorders can affect any part or organ of our body and eyes are not excluded. There are autoimmune disorders of eye too but the fact is that autoimmune disorders of the other parts of our body can affect the eyes indirectly and can give rise to ocular manifestations at any point.

Although most of the eye complications associated with autoimmune disorders involve the cornea but it may also include the conjunctiva, uvea, sclera, retina, and surrounding structures. These eye ailments need to be treated by an ophthalmologist to control eye destruction and avoid further complications.

Common autoimmune disorders and their related eye disorders:

Rheumatoid arthritis

  • Keratoconjunctivitis sicca
  • Scleritis
  • Episcleritis
  • Keratitis
  • Ulcerative keratitis
  • Choroiditis
  • Retinal vasculitis
  • Episcleral nodules
  • Retinal detachment
  • Macular oedema

Sjogren’s syndrome

  • Keratoconjunctivitis sicca

Ankylosing spondylitis

  • Uveitis

Systemic lupus erythematosus

  • Keratoconjunctivitis sicca
  • Conjunctivitis
  • Uveitis
  • Episcleritis
  • Scleritis
  • Keratitis
  • Retinal haemorrhages
  • Retinal vasculitis
  • Proliferative retinopathy
  • Optic neuritis
  • Ischemic optic neuropathy
  • Hemianopia
  • Pupillary abnormalities
  • Oculomotor abnormalities
  • Visual hallucinations

Multiple sclerosis

  • Optic neuritis
  • Retro-bulbar neuritis
  • Visual field defects
  • Inter-nuclear ophthalmoplegia
  • Dysmetria
  • Nystagmus
  • Cranial nerve palsies

Graves’ disease

  • Proptosis/exophthalmos
  • Keratitis
  • Relative afferent pupillary defect

Sarcoidosis

  • Uveitis
  • Conjunctival nodules
  • Cranial nerve palsies
  • Enlarged lacrimal glands
  • Optic neuropathy

Eye symptoms in autoimmune disease

The autoimmune disorders not only show devastating systemic symptoms but may also show following ocular effects:

  • Dryness
  • Redness
  • Headaches
  • Sore eyes
  • Foreign-body sensation
  • Pruritus
  • Sensitivity to light
  • Eye pain
  • Visual changes
  • Loss of color vision
  • Complete loss of vision

Signs of corneal involvement in autoimmune disorders

  • Corneal opacification
  • Corneal vascularization
  • Corneal ulceration
  • Diminished corneal tear meniscus
  • Abnormal Schirmer’s test

Diagnosis of Eye disorders associated with autoimmune disorders

All the above and many more autoimmune disorders need a thorough ophthalmic examination including:

  • Visual acuity
  • Schirmer’s test
  • Slit lamp examination
  • Pupillary reaction
  • Ocular motility
  • Confrontation field testing
  • External inspection
  • Direct ophthalmoscopy with fluorescein staining

This is required as almost all the autoimmune disorders are associated with ocular symptoms that need to be managed to avoid eye complications.

Management of Ocular manifestation of autoimmune disease

If a patient is aware of his autoimmune disorder, then it becomes very necessary for him to take care of his eyes too and get them checked at regular intervals to prevent ocular disabilities. Early and accurate diagnosis with prompt treatment by an ophthalmologist can save the vision and other eye problems.

  • Treating the main systemic disorder generally relieves the ocular manifestations
  • Controlling ocular effects with
    • Artificial tears
    • Nonsteroidal anti-inflammatory drugs
    • Topical/oral/IV Corticosteroids
    • Immunosuppressive agents
  • Prevention measures like:
    • Wearing sunglasses
    • Using room humidifiers
  • Surgical intervention when visual function is threatened