HomeHealth TopicAutoimmune Disorder

Dry Eyes, Blurred Vision, Light Sensitivity: How Autoimmune Diseases Affect Your Eyes

Heidi I. Becker, MD
Published on March 29, 2021

Key takeaways:

  • Autoimmune diseases cause the body to attack itself.

  • Uncontrolled autoimmune diseases can damage the eyes and vision.

  • Medications used to control autoimmune diseases can rarely harm the eyes.

Older woman taking off her glasses and rubbing her eyes with her fingers.
fizkes/iStock via Getty Images

Autoimmune diseases are a large collection of conditions where cells in the body begin to attack the body’s own tissues. Autoimmune diseases can affect almost every part of the body. The eyes are no exception. In fact, the eyes are very commonly affected in many autoimmune diseases. 

Here, we’ll review some of the conditions that can arise when autoimmune diseases target the eyes. We’ll also look at the symptoms of these conditions and common treatments. Finally, we’ll discuss some of the medicines used to control autoimmune diseases that can have side effects on the eyes.

Which autoimmune diseases have symptoms that affect the eyes?

Some autoimmune diseases that commonly affect the vision and eyes are:

Other autoimmune conditions that can cause problems with vision and the eyes are: 

Eye problems can also be a feature of some rarer autoimmune conditions, such as: 

  • Polyarteritis nodosa

  • Granulomatosis with polyangiitis (also known as Wegener’s)

  • Scleroderma

  • Behcet’s disease

  • Reactive arthritis 

What are the different eye problems that can be caused by autoimmune diseases?

Dry eyes 

Dry eyes is caused by not having enough tears on the surface of your eyes. Dry eyes can cause gritty, irritated eyes and blurry vision. When severe, dry eyes can cause permanent damage to your cornea and affect your vision. 

Dry eyes is the main symptom in Sjogren’s syndrome. Dry eyes in Sjogren’s syndrome and other autoimmune diseases is caused by inflammation of the lacrimal gland, the gland that makes liquid tears. 

When dry eyes occurs with other autoimmune diseases — like rheumatoid arthritis, systemic lupus erythematosus (SLE), and scleroderma — it is sometimes called secondary Sjogren’s syndrome.

Over-the-counter artificial tears, lubricating gels, and ointments can all help with dry eyes caused by autoimmune diseases. These work by adding moisture back to the eyes’ surface. Prescription eye drops such as steroids, cyclosporine (Restasis), and lifitegrast (Xiidra) may also help dry eyes. Serum tears are another effective way to treat dry eyes. Punctal plugs can be used to close the tear drainage system and keep natural and artificial tears on the eye’s surface longer.

Scleritis

Scleritis is when the white part of the eye becomes inflamed. It causes redness in the white part, and it also often causes deep, aching pain in the eyes. If left untreated, scleritis can cause thinning of the sclera to the point where it may open up, or perforate. This can cause permanent damage to the eye and your vision.

Rheumatoid arthritis is one of the more common autoimmune diseases associated with scleritis.

Other autoimmune diseases that can cause scleritis include: 

  • Lupus

  • Inflammatory bowel disease

  • Sjogren’s syndrome

  • Scleroderma

  • Polyangiitis (formerly Wegener’s)

Scleritis is typically treated with oral non-steroidal anti-inflammatory medications (NSAIDs) or steroids to control the inflammation. Steroid drops such as prednisolone acetate (Pred Forte, Omnipred) or NSAID drops such as ketorolac (Acular, Acular LS, Sprix) may also be used.

Uveitis

Uveitis is when the inside of the eye, also called the uvea, becomes inflamed. There are three main types of uveitis: anterior, intermediate, and posterior.

Anterior uveitis

Also called iritis, anterior uveitis occurs in the front of the eye. It causes redness, painful light sensitivity, and blurred vision. If it is not controlled, anterior uveitis can cause scar tissue to form inside the eye and permanently damage the vision.

Anterior uveitis can occur in people with ankylosing spondylitis and inflammatory bowel disease. Sarcoidosis also causes anterior uveitis. 

Painless anterior uveitis can occur in children with rheumatoid arthritis (a condition called juvenile idiopathic arthritis, or JIA). This is why children with JIA need regular eye exams.

Anterior uveitis is usually treated first with steroid eye drops like prednisolone acetate or difluprednate (Durezol). If these drops do not help, steroid injections around the eye and/or steroids by mouth may be prescribed. As with autoimmune diseases, if the condition is not controlled with steroids or requires frequent or long-term steroids, then steroid-sparing medicines may be recommended and prescribed.

Intermediate uveitis 

Intermediate uveitis occurs in the center of your eye, in the vitreous cavity. Intermediate uveitis can cause blurry vision and floaters in your vision. Unlike anterior uveitis, it does not typically cause pain.

People who have multiple sclerosis (MS) are known to develop intermediate uveitis, which is also sometimes called pars planitis. It is not yet known if MS directly causes intermediate uveitis or if people with MS are simply more prone to developing this condition.

Like anterior uveitis, intermediate uveitis is treated with steroids.

Posterior uveitis

Posterior uveitis occurs in the retina or choroid, which is in the back part of the eye.

With this condition, the retina and/or the blood vessels that supply the retina become inflamed. This causes blurry vision, and it is usually not painful.

Posterior uveitis can be a symptom of sarcoidosis, lupus, and a rare condition called Vogt-Koyanagi-Harada (VKH) syndrome

Posterior uveitis is typically treated with steroids injected in or around the eye, as well as steroid medication by mouth.

Panuveitis

Very rarely, all parts of the eye can become inflamed. This is called panuveitis. Panuveitis is treated with steroid medication by mouth.

Optic neuritis

Optic neuritis is swelling of the optic nerve. The optic nerve is the nerve in the back of the eye, and it’s the main connection between the eye and the brain. When it becomes inflamed, it is called optic neuritis. Optic neuritis causes blurry vision, loss of peripheral vision, and pain with eye movements.

Optic neuritis can happen to people without autoimmune disease. But it also happens to be very strongly linked to MS. In fact, optic neuritis is one of the common early signs of MS. Between 15% and 20% of people have optic neuritis as a first symptom of MS, and as many as 50% of people with MS have had optic neuritis in the previous 15 years. 

Optic neuritis can also happen along with uveitis in other autoimmune diseases, such as lupus.

Optic neuritis may get better without treatment. But prescription steroid medication taken either by mouth or intravenously (IV) will usually help it heal more quickly.

Thyroid Eye Disease 

Thyroid Eye Disease (TED) — also called Graves’ Eye Disease — occurs when the cells that attack the thyroid gland also attack parts around the eye. This condition causes the muscles around the eye to swell, the eyelids to tighten, and the eyeballs to bulge. This can make it more difficult for the eyelids to close. The swollen eye muscles can also put pressure on the optic nerve. These changes can cause blurred vision and double vision.

Common treatments for TED include over-the-counter lubricants for dry eyes and steroid medicine by mouth or IV to calm the inflammation. More recently, monoclonal antibodies like Tepezza have been used for TED. When TED changes the eye muscles and eyelids, corrective surgery can be an option.

Can autoimmune diseases lead to blindness if left untreated?

Most autoimmune diseases can be managed with medication. But serious damage and even blindness can happen with autoimmune diseases if they are not treated. Your eye doctor (ophthalmologist) and your autoimmune specialist (rheumatologist) will work together to help treat the problems in the eyes that arise with autoimmune diseases.

Can medications like hydroxychloroquine that treat autoimmune diseases cause eye damage?

Hydroxychloroquine is a medication used to treat many autoimmune diseases. It can be very effective, with few side effects. Rarely, hydroxychloroquine can cause damage to the cells in the macula — the center of the retina — and hurt your vision. This problem, called hydroxychloroquine maculopathy, is more likely if you’re taking higher doses for 5 years or more. If you’re taking hydroxychloroquine, you should have regular eye exams to watch for early signs of hydroxychloroquine maculopathy.

Steroids are often prescribed to control autoimmune diseases. Steroids work very well in most cases and rarely cause serious side effects if used short term. However, they have many side effects if used long term. Steroids can cause problems with the eyes like cataracts and glaucoma.

What over-the-counter medicines can help treat eye symptoms of autoimmune diseases?

Over-the-counter artificial tears, lubricating gels, and ointments can all help with dry eyes caused by autoimmune disease. These work by adding moisture back to the eyes’ surface. Inflammatory conditions are sometimes treated with oral NSAIDs that are available over the counter.

The bottom line 

Autoimmune diseases can have many effects on your body, including your eyes. Changes in your vision and your eyes can occur when autoimmune diseases are uncontrolled. It’s important to monitor your eyes and your vision when taking some medications used to control autoimmune diseases. An eye doctor can work with your primary and autoimmune doctor to help diagnose and treat problems in the eye due to autoimmune diseases.

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