From the Guidelines
Autoimmune eye manifestations primarily include uveitis and episcleritis, which can lead to significant morbidity and potential vision loss if not promptly diagnosed and treated. These conditions often present with symptoms such as eye pain, redness, light sensitivity, blurred vision, and dryness. According to the most recent evidence 1, the management of immune-related ocular toxicities, including uveitis and episcleritis, typically involves topical corticosteroids, cycloplegic agents, and in rare cases, systemic steroids.
Key Conditions and Their Management
- Uveitis: characterized by inflammation of the uvea, can lead to severe consequences if not managed properly, including vision loss 1.
- Episcleritis: an inflammatory condition of the episclera, may be self-limiting but often requires treatment with topical steroids or NSAID to manage symptoms and prevent complications 1.
Treatment Approaches
- Topical corticosteroids are the first line of treatment for uveitis and episcleritis, with the addition of cycloplegic agents for uveitis to reduce pain and prevent synechiae formation 1.
- Systemic steroids may be necessary in severe cases or when there is significant visual compromise 1.
- Biologic agents, such as infliximab, may be considered for severe and treatment-refractory cases, although evidence for this is based on case reports 1.
Importance of Prompt Diagnosis and Referral
- Prompt referral to an ophthalmologist is crucial for patients with suspected autoimmune eye manifestations to prevent permanent vision loss 1.
- A comprehensive evaluation for underlying systemic disease is also important, as autoimmune eye manifestations often occur in association with systemic autoimmune diseases 1.
From the FDA Drug Label
Immune/Autoimmune Events: uveitis, optic neuritis, systemic vasculitis, pleuritis, lupus-like syndrome, serum sickness, polyarticular arthritis, and vasculitis with rash The autoimmune eye manifestations are:
- Uveitis
- Optic neuritis 2
From the Research
Autoimmune Eye Manifestations
The autoimmune eye manifestations can be categorized into several types, including:
- Uveitis, which is an inflammatory process inside the eye and can be anterior, intermediate, or posterior 3, 4, 5
- Episcleritis, which involves the episclera, a thin layer of tissue covering the sclera 6
- Scleritis, which is an inflammation of the sclera and can potentially lead to blindness 6
- Keratitis, which refers to corneal inflammation and is frequently associated with scleritis 6
- Dry eye, which affects nearly 30% of the general population and can be associated with various autoimmune diseases 6
Clinical Features and Treatment
The clinical features and treatment of autoimmune eye manifestations can vary depending on the specific disease and its severity. For example:
- Uveitis can be treated with corticosteroids, immunosuppressive drugs, and biologic agents 4, 7
- Episcleritis and scleritis can be treated with anti-inflammatory medications and immunosuppressive drugs 6
- Keratitis can be treated with anti-inflammatory medications and antibiotics 6
- Dry eye can be treated with artificial tears and other lubricating medications 6
Systemic Autoimmune Diseases and Ocular Involvement
Systemic autoimmune diseases can often involve the eyes, and the severity of ocular disease can vary between cases. For example:
- Rheumatoid arthritis can be associated with episcleritis and scleritis 6
- Sjogren syndrome can be associated with dry eye and keratitis 6
- Seronegative spondyloarthropathy can be associated with acute anterior uveitis 6
- ANCA-associated vasculitis can be associated with various ocular manifestations, including uveitis and scleritis 6