Immune System Disorders and the Eyes

Immune system disorders can affect virtually any part of the body, including the eyes. Common conditions include rheumatoid arthritis, lupus, scleroderma, Sjogren’s syndrome, multiple sclerosis, and inflammatory bowel disease. Effects on the eyes range from mild redness and dryness to severe inflammation (iritis or uveitis) to effects on the blood vessels and nerves (vasculitis, optic neuritis) which can potentially cause blindness.

Immune System DisorderAssociated Eye Condition(s)
Rheumatoid arthritisdry eyes, episcleritis, scleritis
Lupusdry eyes, uveitits, vasculitis
Sjogren’s syndromedry eyes
Inflammatory bowel diseaseuveitis
Ankylosing spondylitisuveitis
Scleroderma/Systemic sclerosisdry eyes, vasculopathy
Multiple sclerosisoptic neuritis, double vision
Sarcoidosisuveitis, lacrimal gland enlargement, eyelid nodules

Funduscopic photo of an 86-year-old woman with scleroderma/lupus overlap syndrome demonstrating multiple cotton-wool spots on the retina of each eye. Cotton-wool spots are whitish-yellow fluffy areas on the retina which represent occlusions of small arteries. While they are typically seen with severe diabetes and high blood pressure, they may also occur with certain immune system disorders.

A 74-year-old woman with sarcoidosis affecting left upper eyelid and lacrimal gland.

Any patient with a known immune system disorder who experiences new eye symptoms should be examined. Often, primary care physicians and rheumatologists who are evaluating a patient for a potential immune system disorder will request an eye examination to assist with the diagnosis. Eye findings can lead to earlier and more accurate diagnoses allowing quicker treatment with many of the new immune modifying medications now available.

Read Dr. Warwar’s article on lupus/scleroderma and cotton wool spots and more published article content at: