i, ps

kh Ma
D
50%

eyelid lesions (discoid lupus erythematosus)

M
20% secondary Sjögren syndrome

scleral inflammatory disease

cranial nerve palsies

optic neuropathy neuro-ophthalmic lesions

ye d
retrochiasmal and cerebral visual disorders

rare
uveitis
anterior or intermediate uveitis, are not
commonly associated with SLE

ha in
women of childbearing age
independently of hypertension epidemiology
higher incidence among African Americans
and Hispanics in US

B-lymphocyte hyperactivity polyclonal B-lymphocyte activation

cotton-wool spots with or without intraretinal
hemorrhages
hypergammaglobulinemia

as M
antinuclear antibodies (ANA)
Figure 6-16 (© 2020 American
Academy of Ophthalmology) anti-ssDNA and anti-dsDNA

vitreous hemorrhage antibodies to cytoplasmic components (anti-

secondary retinal neovascularization
autoimmune disorder characterized by Sm, anti-Ro, and anti-La)
pathogenesis autoantibody formation
lupus retinopathy
ocular manifestations in association with SLE and other rheumatic
severe retinal vascular occlusive disease diseases
retinal nonperfusion and ischemia
(arterial and venous thrombosis)
antiphospholipid antibodies antiphospholipid antibody syndrome (APS)
deep venous thrombosis is the most common

M gy
venous or arterial thrombosis
type of thrombosis

Figure 6-17 (© 2020 American Academy of Ophthalmology)

T-lymphocyte autoreactivity with immune
3% with mild disease complex deposition
an important marker of systemic disease
activity
29% with more active disease association with HLA-DR2 and DR3

CNS lupus 9.6.9. Posterior Uveitis (II): 70%–80%

associated with Collagen Vascular Diseases
malar rash
retinal vascular thrombosis hypercoagulable state antiphospholipid antibodies (II): Systemic Lupus
o serous elevations of the retina, retinal pigment
epithelium (RPE), or both

choroidal infarction
Erythematosus acute cutaneous diseases discoid lupus

photosensitivity

mucosal lesions
an ol
choroidal neovascularization (CNV) arthritis 80%–85%

systemic manifestations
lupus choroidopathy renal disease 50%–75%

Raynaud phenomenon 30%–50%

neurologic involvement 35%

m lm

Figure 6-18 (© 2020 American Academy of Ophthalmology) cardiac, pulmonary, hepatic, and hematologic
abnormalities

arteriolar narrowing
SLICC criteria for diagnosis of SLE See Table 9-1
disc edema

NSAIDs ANA testing in patients with no systemic or

ocular findings to suggest SLE has a very high
false-positive rate
need monitoring for cataracts and glaucoma corticosteroids
Ar ha

lab testing
with signs or symptoms suggestive of SLE
IMT
ANA testing should be limited to patients
who have juvenile idiopathic arthritis
plasmapheresis

systemic antihypertensive medications

control of the underlying disease

antiplatelet therapy
patients with severe vaso-occlusive disease or
antiphospholipid antibodies
systemic anticoagulation treatment

to ameliorate skin, joint, and constitutional

t

symptoms and prevent relapses

may help prevent nephritis and ANA-mediated hydroxychloroquine

ph

thrombosis

need monitoring for retinal toxicity

panretinal photocoagulation proliferative retinopathy

vitrectomy surgery vitreous hemorrhage

O

Ophthalmology Mind Maps/Arman Mashayekhi, MD