Eye

Autoimmune eye: Autoimmune Diseases That Affect the Eyes

by alexxlab

Autoimmune Diseases That Affect the Eyes

An autoimmune disease occurs when the natural defense system of a body is not able to differentiate its own cells from foreign cells. As a result, the immune system mistakenly attacks normal cells. Nearly every part of the body – including the eyes – can take the brunt of autoimmune diseases.

In this article, a reputable eye clinic takes a closer look at some of the autoimmune diseases that can heavily affect the eyes, the common symptoms of these conditions and their risk factors.

Autoimmune Diseases That Are Linked to Vision Health

There are more than 80 types of autoimmune diseases that affect a wide range of body parts, from nerves and joints to eyes. Some autoimmune diseases that typically affect the eyes are:

Behcet Disease
This rare autoimmune disease characterized by ocular lesions, skin lesions and genital ulcers is a leading case of blindness in some parts of the world. It can affect the anterior and posterior portions of the eye.

Crohn’s Disease
This type of inflammatory bowel disease causes swelling of the tissues in the digestive tract. The main eye-related problem that can occur with Crohn’s disease is episcleritis, a common and benign cause of red eye.

Diabetes
A potential effect of diabetes is swelling of the eye lens. If blood sugar levels change from low to normal too quickly, the shape of the eye lens can be affected, leading to blurred vision. High blood sugar can also damage the blood vessels in the retina, the light-sensitive part of the eye.

Lupus
Inflammation caused by lupus can affect many systems of the body, including the skin, brain, heart and lungs. The effects of lupus in and around the eyes include inflammation of the white outer layer of the eyeball, changes in the skin around the eyelids and damage to nerves controlling eye movement.

Multiple Sclerosis
This is a lifelong condition that can affect the brain and spinal cord. Optic neuritis or inflammation of the optic nerve is a common symptom of this disease. It usually occurs in one eye and can cause blurred vision, loss of color vision and pain with eye movement.

Psoriasis
A common chronic skin disease, psoriasis causes rashes with itchy, scaly patches all over the body, most typically on the scalp, knees and elbows. Some types of psoriasis are linked to a heightened risk of developing inflammatory eye conditions, such as conjunctivitis or inflammation of the eyelid.

Reactive Arthritis
Formerly known as Reiter’s syndrome, reactive arthritis is a condition that causes redness and swelling in various joints of the body. Many people with this condition also develop conjunctivitis.

Rheumatoid Arthritis
This is an autoimmune and inflammatory disease that causes painful swelling in affected parts of the body. Its most common eye-related symptom is dryness of the sclera, which, if left untreated, can cause damage to the cornea, the clear surface that helps the eye focus.

Sjogren’s Syndrome
A disorder of the immune system, Sjogren’s syndrome is identified by its two most common symptoms: dry eyes and a dry mouth. Because of the decrease in tear production, the eyes may feel extremely dry, itchy or burning.

Thyroid Diseases
This is a group of autoimmune diseases that result in high or low thyroid function. It increases the risk of developing glaucoma, a condition that causes high pressure inside the eye. With Graves’ disease, for instance, tissues build up around the eye and increase pressure. With low-thyroid disorders, on the other hand, pressure builds up because the eye is not able to effectively circulate its fluids.

Uveitis
This is an autoimmune disease that directly affects the middle layer of tissue in the eye wall called uvea. Its common symptoms include eye redness, pain and blurred vision. It can affect one or both eyes and can cause vision loss if left untreated by an eye specialist.

Risk Factors of Autoimmune Diseases

While the exact cause of autoimmune diseases is unknown, some people are more likely to develop an autoimmune disease than others. Risk factors that increase the chances of developing autoimmune diseases include:

Genetics: Certain autoimmune diseases like lupus and multiple sclerosis do tend to run in families, meaning that certain genes make some people more likely to develop them. Viruses, chemicals and other things in the environment can trigger an autoimmune disease if the body already possesses the genes for it.

Weight: Obesity increases the risk of developing rheumatoid arthritis or psoriatic arthritis. This could be due to heavier weight putting significant strain on the joints or fat tissues producing substances that encourage inflammation.

Smoking: Research has also linked smoking to the development of several immune and autoimmune diseases, such as lupus, rheumatoid arthritis, hyperthyroidism and multiple sclerosis. Smoking has wide-reaching effects on the immune system, including increasing inflammation levels and allergic conditions.

Medications: Some blood pressure medications or antibiotics can trigger drug-induced lupus, a generally milder version of the idiopathic disorder. Specific medications used to lower cholesterol can also trigger statin-induced myopathy, a rare autoimmune disease causing muscle weakness.

Medicines That Can Help Treat Eye Symptoms of Autoimmune Diseases

Fortunately, there are over-the-counter medicines that can help alleviate the eye-related symptoms of autoimmune diseases. These include artificial tears, lubricating gels and ointments, all of which can help with dry eyes. These medicines bring moisture back to the surface of the eye. Other inflammatory conditions are sometimes treated with oral non-steroidal anti-inflammatory drugs that are available over the counter. Patients who do not respond to oral medications should be referred to an ophthalmologist for possible treatment with immunosuppressive medications.

The Importance of Getting Regular Eye Examinations

Aside from eating a balanced diet and leading a healthy lifestyle, one of the most critical steps to preserve eyesight is to regularly attend appointments with an ophthalmologist. According to the American Academy of Ophthalmology, all adults should undergo eye screening at age 40 to maintain healthy vision, especially if they have not seen an eye specialist previously. Generally, however, adults aged 18 to 60 should get a comprehensive eye exam at least every two years.

If you happen to be affected by an autoimmune disease:

  • You should not wait until you are 40 years old to get a vision health screening. If you have not been to an ophthalmologist in the past year, it will be for your own benefit to see one now.

  • Make sure you talk to your doctor about how often you need a vision screening. If you are experiencing symptoms related to vision health issues, then you will definitely need to get screened more frequently. Some patients get screened as often as every six months, but this is for severe cases.

  • It is also important to get regular eye examinations if you are taking medications for autoimmune disease treatment, such as hydroxychloroquine, which can cause ocular toxicity to various parts of the eye. Other medications for autoimmune diseases that can have negative effects on vision health include corticosteroids, which can increase the risk of cataracts and glaucoma when used long-term.

Most autoimmune diseases can be managed with medication, although serious eye damage and, in some cases, blindness can happen if they are not treated. An eye doctor and an autoimmune specialist should work closely together to effectively treat eye symptoms that occur with autoimmune diseases.

Uveitis – Causes – NHS

Uveitis happens when the eye becomes red and swollen (inflamed).

Inflammation is the body’s response to illness or infection.

Most cases of uveitis are linked to a problem with the immune system (the body’s defence against infection and illness).

Rarely, uveitis may happen without the eye becoming red or swollen.

Immune system problems

Uveitis often happens in people who have an autoimmune condition. This is where the immune system mistakenly attacks healthy tissue.

Autoimmune conditions known to cause uveitis include:

  • ankylosing spondylitis – a condition where the spine and other areas of the body become inflamed
  • reactive arthritis – a condition that causes inflammation in various areas of the body
  • conditions that cause bowel inflammation – such as Crohn’s disease and ulcerative colitis
  • psoriasis – a skin condition
  • psoriatic arthritis – a type of arthritis that develops in some people with psoriasis
  • multiple sclerosis – a condition mainly affecting the nerves
  • Behçet’s disease – a rare condition that causes mouth ulcers and genital ulcers
  • sarcoidosis – a rare inflammatory condition that affects the lungs, skin and eyes
  • juvenile idiopathic arthritis– a type of arthritis that affects children

Infection

Uveitis can also be caused by an infection, such as:

  • toxoplasmosis – an infection caused by a parasite
  • herpes simplex virus – the virus responsible for cold sores
  • varicella-zoster virus – the virus that causes chickenpox and shingles
  • cytomegalovirus – a common infection that does not usually cause any noticeable symptoms, but can cause sight-threatening uveitis in people with a lowered immune system
  • tuberculosis
  • HIV and syphilis are rare causes

Other causes

Uveitis can also be caused by:

  • trauma or injury to the eyes, or eye surgery
  • some types of cancers, such as Non-Hodgkin lymphoma, although this is a very rare cause of uveitis

Sometimes, a specific cause of uveitis cannot be identified.

Gene HLA-B27

Although uveitis is not passed down through families, a gene known as HLA-B27 has been linked to an increased risk of developing uveitis at the front of the eye (anterior uveitis).

About half of all people with anterior uveitis have the HLA-B27 gene. The gene has been found in people with certain autoimmune conditions, including ankylosing spondylitis and ulcerative colitis.

Page last reviewed: 03 January 2020
Next review due: 03 January 2023

Features of ophthalmic pathology in autoimmune diseases | Lukashenko

1. Basantsova N.Yu., Zinchenko Yu.S., Starshinova A.A., Yablonsky P.K. Features of the diagnosis of neuropathy of small fibers in various diseases (literature review) // Pediatrician, 2018. V. 9, No. 6. P. 101-110.

2. Vizel A.A. Sarcoidosis: monograph. M.: Atmosfera, 2010. 416 p.

3. Godzenko A.A. Prospects for the treatment of uveitis in rheumatic diseases // Modern Rheumatology, 2011. V. 2, No. 37. C. 42.

4. Zaitseva N.S., Katsnelson L.A. Uveitis. Moscow: Medicine, 1984. 318 p.

5. Kansky D. Clinical ophthalmology: a systematic approach. Per. from English. M.: Logosfera, 2006. P. 744.

6. Plekhanov A.N., Fomina A.S., Sverkunova O.P., Ivanova Yu.V. Autoimmune uveitis. Review // Ophthalmology, 2019. V. 16, No. 1. P. 5-11.

7. Polunin G.S., Safonova T.N., Polunina E.G. Features of the clinical course of various forms of dry eye syndrome – the basis for the development of adequate methods of treatment // Bulletin of the ophthalmologist, 2006. V. 102, No. 5. P. 17-20.

8. Roit A, Brostoff J, Meil ​​D. Immunology. Per. from English. M.: Mir, 2000. 208 p.

9. Ustinova E.I. Endogenous uveitis (selected lectures for ophthalmologists). St. Petersburg: Eco-Vector, 2017. 204 p.

10. Shishkin A.N. Diffuse diseases of connective tissue / Systemic pathology of connective tissue. Ruk. For doctors / Ed. Yu.I. Stroeva, L.P. Churilova. St. Petersburg: Elbi-SPb, 2014. S. 282-313.

11. Akiki R.K., Statler B., Greenberg P.B., Janigian R.H. Unilateral birdshot chorioretinopathy in an elderly patient. R.I. Med. J., 2019Vol. 102, no. 1, pp. 60-61.

12. Alhatem A., Cavalcanti B., Hamrah P. In vivo confocal microscopy in dry eye disease and related conditions. Semin. Ophthalmol., 2012, Vol. 27, no. 5-6, pp. 138-148.

13. Avichezer D., Chan C.C., Silver P.B., Wiggert B., Caspi R.R. Residues 1-20 of IRBP and whole IRBP elicit different uveitogenic and immunological responses in interferon gamma deficient mice. Exp. Eye Res, 2000, Vol. 71, no. 2, rr. 111-118.

14. Becker M.D., Adamus G., Davey M.D., Rosenbaum J.T. The role of T-cells in autoimmune uveitis. Ocul. Immunol. Inflam., 2000, Vol. 8, no. 2, pp. 93-100.

15. BENITEZ-DEL-CASTILLO J.M., Acosta M.C., Wassfi M.A., Díaz-Valle D., Gegóndez J.A., Fernandez C., Garcíasánchez J. Relation Between Corneal Innervation with Con Focal Microscopy and Corneal Sensitivity with NonContact Esthesiometry in Pathents with Dry eye. Invest. Ophthalmol. Vis. Sc., 2007, Vol. 48, no. 1, rr. 173-181.

16. Bose T., Diedrichs-Möhring M., Wildner G. Dry eye disease and uveitis: A closer look at immune mechanisms in animal models of two ocular autoimmune diseases. J. Autoimmun. Rev., 2016, no. 15 (12), pp. 1181-1192.

17. Boulton A.J., Malik R.A., Arezzo J.C., Sosenko J.M. Diabetic somatic neuropathies. Diabetes Care, 2004, Vol. 27, no. 6, rr. 1458-1486.

18. Coulon C., Kodjikian L., Rochepeau C., Perard L., Jardel S., Burillon C., Broussolle C., Jamilloux Y., Seve P. Ethnicity and association with ocular, systemic manifestations and prognosis in 194 patients with sarcoid uveitis. Graefes. Arch. Clin. Exp. Ophthalmol., 2019, Vol. 257, no. 11, pp. 2495-2503.

19. Cruzat A., Qazi Y., Hamrah P. In vivo confocal microscopy of corneal nerves in health and disease. Ocul. Surf., 2017, Vol. 15, no. 1, pp. 15-47.

20. Davatchi F. Behcet’s disease. J. Int. Rheum. Dis., 2014, Vol. 17, no. 4, pp. 355-357.

21. Davatchi F., Shahram F., Chams-Davatchi C., Shams H., Nadji A., Akhlaghi M., Faezi T., Ghodsi Z., Faridar A., ​​Ashofteh F., Abdollahi B.S. Behcet’s disease: from east to west. Clin. Rheumatol., 2010, Vol. 29, no. 8, pp. 823-833.

22. Direskeneli H. Behçet’s disease: infectious aetiology, new autoantigens, and HLA-B51. Ann. Rheum. Dis., 2001, Vol. 60, no. 11, pp. 996-1002.

23. Kernel A., Dedorsson I., Johansson B., Wickstrom C.P., Ludvigsson J., Tuvemo T., Neidemd J., Sjostrom K., Malmgreen K., Kanulf P., Mellvig Gjotterberg M., Sule J ., Persson L.A., Larsson L.I., Aman J., Dahlquist. Prevalence of diabetic retinopathy in children and adolescens with IDDM. A population-based multicentre study. Diabetologia, 1997, Vol. 40, no. 3, pp. 307-310.

24. Malik R.A, Kallinikos P., Abbott C.A., van Schie C.H.M., Morgan P., Efron N., Boulton A.J.M. Corneal confocal microscopy: a noninvasive surrogate of nerve fiber damage and repair in diabetic patients. Diabetology, 2003, Vol. 46, pp. 683-688.

25. Malik R.A., Veves A., Walker D., Siddique I., Lye R.H., Schady W., Boulton A.J. Sural nerve fiber pathology in diabetic patients with mild neuropathy: relationship to pain, quantitative sensory testing and peripheral nerve electrophysiology. Acta Neuropathol., 2001, Vol. 101, pp. 367-374.

26. Messmer E.M., Schmid-Tannwald C., Zapp D., Kampik A. In vivo confocal microscopy of corneal small fiber damage in diabetes mellitus. Graefs Arch. Clin. Exp. Ophthalmol., 2010, Vol. 248, no. 9, rr. 1307-1312.

27. Messmer E.M. The pathophysiology, diagnosis, and treatment of dry eye disease. Dtsch Arztebl. Int., 2015, Vol. 112, no. 5, pp. 71-81.

28. Morgan J.P., Robins R.A., Dua H.S., Tighe P.J. S antigen specific effector T cell activation detected by cytokine flow cytometry. Br. J. Ophthalmol., 2002, Vol. 86, no. 5, pp. 517-520.

29. No authors listed. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop. Ocul. Surf., 2007, Vol. 5, no. 2, pp. 75-92.

30. Pasadhika S., Rosenbaum J.T. Ocular Sarcoidosis. Clin. Chest. Med., 2015, Vol. 36, no. 4, pp. 669-683.

31. Pascolini D., Mariotti S.P.M. Global estimates of visual impairment: 2010. Br. J. Ophthalmol., 2012, Vol. 96, no. 5, pp. 614-618.

32. Raizman M. Corticosteroid therapy of eye diseases. Arch. Ophthalmol., 1996, Vol. 114, no. 8, rr. 1000-1001.

33. Rosenberg M.E., Tervo T.M., Immonen I.J., Müller L.J., Grönhagen-Riska C., Vesaluoma M.H. Corneal structure and sensitivity in type 1 diabetes mellitus. Invest. Ophthalmol. Vis. Sc., 2000, Vol. 41, no. 2, pp. 2915-2921.

34. Sakane T., Takeno M., Suzuki N., Inaba G. Behçet’s disease. N. Engl. J. Med., 1999, Vol. 341, no. 17, pp. 1284-1291.

35. Sherman M.A., Ardashev I.V. A case of recurrent Devic’s optiomyelitis. J. Nevrol. Psychiatr. Im. S.S. Korsakova, 2015, Vol. 115, no. 2, Pt. 2, pp. 38-44.

36. Tuisku I.S., Konttinen Y.T., Konttinen L. M., Tervo T.M. Alterations in corneal sensitivity and nerve morphology in patients with primary Sjogren’s syndrome. Exp. Eye Res., 2008, Vol. 86, no. 6, rr. 879-885.

37. Tuisku I.S., Lindbohm N., Wilson S.E., Tervo T.M. Dry eye and corneal sensitivity after high myopic LASIK. J. Refract. Surg., 2007, Vol. 23, no. 4, pp. 338-342.

38. Tuominen I.S., Konttinen Y.T., Vesaluoma M.H., Moilanen J.A., Helintö M., Tervo T.M. Corneal innervation and morphology in primary Sjögren’s syndrome. Invest. Ophthalmol. Vis. Sc., 2003, Vol. 44, no. 6, rr. 2545-2549.

39. Villani E., Baudouin C., Efron N., Hamrah P., Kojima T., Patel S.V., Pflugfelder S.C., Zhivov A., Dogru M. In vivo confocal microscopy of the ocular surface: from bench to bedside . Curr. Eye, 2014, Vol. 39, no. 3, pp. 213-231.

40. Yazici H. The place of Behçet’s syndrome among the autoimmune diseases. Int. Rev. Immunol., 1997, Vol. 14, no. 1, rr. 1-10.

41. Zierhut M., Schlote T., Tomida J., Stiemer R. Immunology of uveitis and ocular allergy. Acta Ophthalmol., 2000, Vol. 78, pp. 22-25.

Vision problems and autoimmune disorders

People with autoimmune disorders should carefully monitor their vision.

An autoimmune disorder affects every system in the body, from the nerves and joints to the eyes. To date, more than 80 types of autoimmune disorders are known, but no one can accurately assess their impact on your vision. Every patient with an autoimmune disorder should be aware of how it affects vision. At the slightest disturbance of vision, such as “fog” before the eyes, blurring, pain in the eyes, dryness or photosensitivity, you should immediately consult a doctor.

Modern drugs are successfully used to treat eye diseases caused by autoimmune disorders.

See an ophthalmologist regularly for autoimmune disorders

The best prevention of eye diseases is regular visits to the ophthalmologist. Ophthalmologists recommend that all people over the age of 40 get an eye exam (screening) if they haven’t done it before. Recommendations for patients with autoimmune diseases:

Get your eyes checked, even if you’re under 40. If you haven’t been to an ophthalmologist this year, make an appointment now.

Ask your doctor how often you need to have your eyes checked.

Get your eyes checked more often (every 6 months) if you have the first signs of eye disease.

See your eye doctor regularly if you are taking medications for autoimmune diseases.

Relationship between vision and autoimmune disorders

Autoimmune disorders causing vision problems:

  • Behçet’s disease. A rare autoimmune disorder that is the leading cause of blindness in the population in several developing countries. The disease affects the mucous membranes of the eyes, mouth and genitals.
  • Lupus. One of the complications of lupus is inflammation of the eyes. Symptoms: “fog” before the eyes, headaches, inflamed eyes, dry eyes and photosensitivity.
  • Multiple sclerosis (MS). Multiple sclerosis and visual function are so closely related that it is the ophthalmologist who may be the first to suspect that a patient is developing an autoimmune disorder. In the early stages of MS, patients often present with optic neuritis, which causes gradual or sudden loss of vision due to inflammation of the optic nerve. The optic nerve is a large nerve that leads to the back chamber of the eye.
  • Psoriasis. Inflammation of the conjunctiva (the mucous membrane that covers the white of the eye and the inner surface of the eyelids) causes redness and pain in the eyes.
  • Reiter’s syndrome. Reactive arthritis affects the joints and front of the eyes.
  • Rheumatoid arthritis (RA). RA causes dry eyes, protein inflammation, thinning of the cornea, and other painful visual disturbances.
  • Sjögren’s syndrome is a chronic inflammatory disorder that affects the lacrimal glands and causes dry eyes.
  • Diseases of the thyroid gland. Autoimmune disorders characterized by hyperfunction or dysfunction of the thyroid gland increase the risk of developing glaucoma (increased intraocular pressure). Although there is currently no evidence to support a link between glaucoma and thyroid disease, it is believed that such diseases cause an increase in intraocular pressure, as they are accompanied by an increase in tissue around the eyes (as, for example, in Graves’ disease). With thyroid dysfunction, the circulation of fluid in the eyes is disturbed, which also leads to an increase in intraocular pressure.
  • Type 1 diabetes mellitus.
  • Ulcerative colitis and Crohn’s disease. Approximately 5% of patients present with “non-specific ocular inflammation”.
  • Uveitis is an autoimmune disease that directly affects the pigment cells of the iris and, in some cases, the middle layers of the eye.