Autoimmune diseases are a group of disorders characterized by an abnormal immune response, in which the body’s immune system mistakenly attacks healthy cells and tissues.

While these diseases can affect various organs and systems in the body, they can also have specific manifestations in the eyes. Ocular symptoms are often one of the first indications of an underlying autoimmune condition, and prompt recognition and management are crucial in preventing long-term damage and vision loss.

In this article, we will explore some common autoimmune diseases and their associated ocular symptoms.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disorder primarily affecting the joints. However, it can also cause inflammation in the eyes, leading to several ocular manifestations.

One of the most common eye complications of RA is dry eye syndrome, characterized by insufficient tear production. Patients may experience a gritty or burning sensation, redness, and blurred vision.

Other ocular symptoms include episcleritis (inflammation of the outer layer of the sclera), scleritis (inflammation of the white part of the eye), and keratitis (corneal inflammation).

Lupus (Systemic Lupus Erythematosus)

Lupus is a chronic autoimmune disease that can affect multiple organs, including the skin, joints, kidneys, and eyes.

Ocular involvement in lupus can present as dry eyes, conjunctivitis (inflammation of the conjunctiva), and uveitis (inflammation of the uvea, the pigmented layer in the eye). Additionally, lupus patients may develop a condition called discoid lupus erythematosus, characterized by scaly patches on the eyelids and around the eyes.

Sjögren’s Syndrome

Sjögren’s syndrome is an autoimmune disorder that primarily affects the salivary and lacrimal glands, leading to dry eyes and dry mouth.

Ocular manifestations of Sjögren’s syndrome are mainly related to dryness and can cause significant discomfort. Patients may experience gritty or sandy sensations, blurred vision, light sensitivity, and recurrent eye infections. Dryness can also predispose individuals to corneal ulcers and erosions.

Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, including the brain and spinal cord. While MS primarily causes neurological symptoms, it can also impact the eyes.

Optic neuritis, characterized by inflammation of the optic nerve, is a common ocular manifestation of MS. This condition typically presents with gradual or sudden vision loss, pain with eye movement, and impaired color vision. Optic neuritis is often one of the first symptoms of MS, prompting further evaluation and diagnosis.

Graves’ Disease

Graves’ disease is an autoimmune condition that causes hyperthyroidism, an overactive thyroid gland. This disease can have several ocular manifestations collectively known as Graves’ ophthalmopathy or thyroid eye disease.

Ocular symptoms may include bulging eyes (proptosis), double vision, excessive tearing, redness, grittiness, and sensitivity to light. Graves’ ophthalmopathy can significantly impact the quality of life and may require prompt medical intervention to prevent further complications.

Behçet’s Disease

Behçet’s disease is a rare autoimmune disorder characterized by recurrent oral aphthous ulcers, genital ulcers, skin lesions, and uveitis.

Ocular involvement is a prominent feature of Behçet’s disease, with uveitis being the most common ocular manifestation. Uveitis refers to the inflammation of the uvea and can cause redness, eye pain, blurred vision, and floaters.

It is crucial to manage ocular inflammation promptly in Behçet’s disease to prevent complications like glaucoma, cataracts, and retinal damage.

Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is an autoimmune condition that leads to an underactive thyroid gland. While ocular symptoms are less common in this disease compared to Graves’ disease, dry eyes and mild eye discomfort can still occur.

Conjunctival injection and swelling of the eyelids (periorbital edema) may also be present. It is important to note that ocular symptoms in Hashimoto’s thyroiditis are usually milder and less severe compared to Graves’ ophthalmopathy.

Psoriasis

Psoriasis is a chronic skin condition characterized by scaly plaques that can occur anywhere on the body, including the eyelids and the skin around the eyes. Involvement of the eyelids can cause redness, itching, and swelling.

Psoriasis patients may also develop blepharitis, an inflammation of the eyelid margins, leading to crusting, discomfort, and blurred vision.

Inflammatory Bowel Disease

Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis are chronic conditions characterized by inflammation of the gastrointestinal tract.

While the primary symptoms involve the digestive system, these diseases can also affect the eyes. Uveitis, episcleritis, and scleritis can occur in patients with inflammatory bowel disease, causing eye redness, pain, and visual disturbances.

Early recognition and treatment of ocular inflammation are necessary to prevent complications and promote better overall outcomes.

Rheumatic Diseases (Connective Tissue Diseases)

Connective tissue diseases, including systemic lupus erythematosus, systemic sclerosis (scleroderma), and mixed connective tissue disease, can have various ocular manifestations. These may include dry eyes, scleritis, uveitis, and rarely, retinopathy.

Regular ophthalmic evaluations are important in patients with these conditions to detect any ocular involvement and initiate appropriate management.