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      Ocular findings in systemic lupus erythematosus

      review-article
      Author(s): a , * , a , b , c
      Publication date (Electronic):
      Journal: Saudi Journal of Ophthalmology
      Publisher: Elsevier
      Keywords: SLE, Autoimmune, Ocular complications

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          Abstract

          Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. Ocular complications occur in up to one-third of patients with SLE. The ocular findings may represent the initial manifestation of the disease and may lead to severe ocular morbidity and loss of vision. Early diagnosis and prompt management of patients with SLE are mandatory and require collaboration between the ophthalmologist and the rheumatologist.

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          Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.

          M Hochberg (1997)
          Article 0 comments Cited 811 times – based on 0 reviews     Review now
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            Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy.

            Michael F Marmor, Ulrich Kellner, Timothy Lai … (2011)
            The American Academy of Ophthalmology recommendations for screening of chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy were published in 2002, but improved screening tools and new knowledge about the prevalence of toxicity have appeared in the ensuing years. No treatment exists as yet for this disorder, so it is imperative that patients and their physicians be aware of the best practices for minimizing toxic damage. New data have shown that the risk of toxicity increases sharply toward 1% after 5 to 7 years of use, or a cumulative dose of 1000 g, of HCQ. The risk increases further with continued use of the drug. The prior recommendation emphasized dosing by weight. However, most patients are routinely given 400 mg of HCQ daily (or 250 mg CQ). This dose is now considered acceptable, except for individuals of short stature, for whom the dose should be determined on the basis of ideal body weight to avoid overdosage. A baseline examination is advised for patients starting these drugs to serve as a reference point and to rule out maculopathy, which might be a contraindication to their use. Annual screening should begin after 5 years (or sooner if there are unusual risk factors). Newer objective tests, such as multifocal electroretinogram (mfERG), spectral domain optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF), can be more sensitive than visual fields. It is now recommended that along with 10-2 automated fields, at least one of these procedures be used for routine screening where available. When fields are performed independently, even the most subtle 10-2 field changes should be taken seriously and are an indication for evaluation by objective testing. Because mfERG testing is an objective test that evaluates function, it may be used in place of visual fields. Amsler grid testing is no longer recommended. Fundus examinations are advised for documentation, but visible bull's-eye maculopathy is a late change, and the goal of screening is to recognize toxicity at an earlier stage. Patients should be aware of the risk of toxicity and the rationale for screening (to detect early changes and minimize visual loss, not necessarily to prevent it). The drugs should be stopped if possible when toxicity is recognized or strongly suspected, but this is a decision to be made in conjunction with patients and their medical physicians. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Ocular Manifestations of Systemic Lupus Erythematosus: A Review of the Literature

              Neal V Palejwala, Harpreet Walia, Steven Yeh (2012)
              About one-third of patients suffering from systemic lupus erythematosus have ocular manifestations. The most common manifestation is keratoconjunctivitis sicca. The most vision threatening are retinal vasculitis and optic neuritis/neuropathy. Prompt diagnosis and treatment of eye disease is paramount as they are often associated with high levels of systemic inflammation and end-organ damage. Initial management with high-dose oral or IV corticosteroids is often necessary. Multiple “steroid-sparing” treatment options exist with the most recently studied being biologic agents.
              Article 0 comments Cited 62 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Samir S. Shoughy
                Journal
                Journal ID (nlm-ta): Saudi J Ophthalmol
                Journal ID (iso-abbrev): Saudi J Ophthalmol
                Title: Saudi Journal of Ophthalmology
                Publisher: Elsevier
                ISSN (Print): 1319-4534
                Publication date PMC-release: 16 February 2016
                Publication date (Print): Apr-Jun 2016
                Publication date (Electronic): 16 February 2016
                Volume: 30
                Issue: 2
                Pages: 117-121
                Affiliations
                [a ]The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia
                [b ]Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
                [c ]The Wilmer Ophthalmological Institute of The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
                Author notes
                [* ]Corresponding author at: The Eye Center, PO Box 55307, Riyadh 11534, Saudi Arabia.The Eye CenterPO Box 55307Riyadh11534Saudi Arabia samir.shawki@ 123456hotmail.com
                Article
                Publisher ID: S1319-4534(16)00024-2
                DOI: 10.1016/j.sjopt.2016.02.001
                PMC ID: 4908056
                PubMed ID: 27330388
                SO-VID: 96407bd9-7a9f-4171-adbf-7202c34281b3
                Copyright © © 2016 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 11 March 2015
                Date revision received : 5 January 2016
                Date accepted : 9 February 2016
                Categories
                Subject: Review Article

                Keywords: sle,autoimmune,ocular complications
                Data availability:
                Keywords: sle, autoimmune, ocular complications

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