A case to illustrate the role of ophthalmologist in systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) affects the eye as part of the disease or due to the drugs used in therapy. Ocular involvement is seen in one third of the patients with SLE. SLE is rare in India and found less frequently in males and children. SLE retinopathy is usually bilateral. We report an unusual case of unilateral macular infarction in a boy caused by systemic lupus erythematosus. A fourteen year old boy was presented with skin rashes and loss of vision in left eye. Posterior segment examination showed hyperemic edematous disc, arteriolar attenuation, venous dilatation, multiple cotton wool spots around the disc and macula in the left eye. There was no improvement in vision with pulse steroids and cyclophosphamide. The clinical implication of SLE retinopathy is that the disease is severe and warrants systemic immunosuppressive therapy. SLE-induced macular infarction is rare and has poor visual prognosis. As serious ocular complications of SLE can be silent, routine ophthalmological evaluation is warranted in all patients.

Keywords: India; Systemic lupus erythematosus; lupus retinopathy; macular infarction; unilateral.

Figure 1

Discoid rashes on face and trunk

Figure 2

Left eye fundus. Yellow arrow – Disc pallor (optic atrophy), Red arrow – vascular sheathing, Green arrow – Macular scarring, Black arrow – Cotton wool spot