Lupus and Chronic Dry Eye

Reviewed by: HU Medical Review Board

Lupus is a chronic (long-term), autoimmune disease. Autoimmune conditions cause the immune system to mistakenly attack certain healthy parts of the body. Lupus affects multiple organ systems, but it most commonly involves the skin, joints, kidneys, and brain. The symptoms and severity of the disease can vary widely among people.1

Dry eyes commonly occur in those with lupus. There are several reasons why dry eyes may occur with lupus. Drugs used to treat lupus and additional conditions that may occur along with lupus are some reasons dry eye may occur.

Medicine, lupus, and dry eyes

Dry eye symptoms in lupus may be caused or made worse by the drugs used to treat lupus, including immunosuppressants.2,3

Lupus occurs when the body mistakenly attacks healthy cells in the body. Most immunosuppressant drugs work to “turn down” (suppress) this attack by preventing certain cells of your immune system from dividing. Certain immunosuppressants may lead to symptoms of dry eyes.2,3

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Lupus, Sjögren’s syndrome, and dry eye

Sjögren’s syndrome is also an autoimmune condition. Most commonly, Sjögren’s syndrome affects the tear and saliva glands. It can also impact other moisture-producing areas, like the nose, throat, skin, or vagina.4-7

Researchers estimate that 14 to 18 percent of people living with lupus also have Sjögren’s syndrome. It is considered primary Sjogren’s syndrome when it occurs on its own, with no other autoimmune conditions present. If a person develops Sjögren’s syndrome in the setting of another autoimmune issue, it is considered secondary Sjögren’s syndrome.4-7

While researchers do not know the exact reason why Sjögren’s syndrome and lupus may run together, people with 1 autoimmune condition seem to be more likely to develop additional autoimmune conditions.4-7

Drugs used to treat Sjogren’s may impact the eyes. These drugs may not directly cause dry eye disease. However, they may be used in those with dry eyes caused by Sjögren’s. Some of these drugs include:2,8,9

  • Antimalarial drugs – High doses of the antimalarial drug hydroxychloroquine can be toxic to the retina. People taking hydroxychloroquine should get a baseline eye exam before or soon after beginning the drug, along with regular eye exams to monitor for retinal damage as long as they take the drug.
  • Steroids – Also called corticosteroids, these drugs can impact the eyes. Long-term use of these drugs can increase the pressure within the eye. This may lead to open-angle glaucoma, a disease of increased eye pressure that damages the nerve inside the eye. Glaucoma is progressive (gets worse over time) and is the second-leading cause of blindness worldwide. Glaucoma is often treated with eye drops that have been widely shown to lead to dry eye symptoms.

How are dry eyes from lupus treated?

Regular eye exams can help your doctor spot serious complications early enough for successful treatment. The type of treatment will depend upon what type of symptoms you are having.

For many, dry eye symptoms may be treated with over-the-counter eye drops or prescription eye drops that increase the amount of wetness on the eyes. Humidifiers and eye shields may also help combat dryness. Surgery may be an option for some. Punctal plug surgery blocks the tear duct from draining tears, allowing the tears to remain in the eye.5

Drug-induced eye symptoms are treated by reducing the drug in question, if possible.2,3