Ocular findings in systemic lupus erythematosus.

25 years ago systemic lupus erythematosus was a relatively obscure entity.Much has since been published and lupus has achieved the status of a well-recognized and not uncommonly diagnosed condition.It is a multi-system disorder classified with the "colla- gen diseases", and its manifestations are protean.The joints, skin, kidneys, and cardio- pulmonary system are most commonly affected.In addition, there may be involvement of the eye, blood, liver, spleen, bones, lymph nodes, nervous tissue, and gastrointestinal system (Dubois and Tuffanelli, I964; Larson, I96I).Though the precise aetiology is obscure, it appears that abnormal immunological processes play a part in its pathogenesis.In the present study we report the results of ocular examinations in a series of 6 I patients with systemic lupus, and contrast our findings with those of a number of earlier series.We emphasize that the concept ofa fairly high incidence ofocular manifestations in systemic lupus erythematosus is no longer valid.It was based on earlier studies in which patients were, for the most part, either not treated or inadequately treated by current standards.Today's patients, treated more successfully for systemic lupus, rarely present with ocular signs or symptoms. Material and methodsThe 6I patients (51 women and Io men) were referred from the systemic lupus clinic of Bellevue Hospital, and were seen at a total of 270 visits (ranging from I to Io examinations per patient) by one ofus (P.H.) over the past IO years.The diagnosis was confirmed by positive LE-cell preparations or, in a few cases, by antinuclear antibody studies.When these patients were seen, their disease was essentially under control.The majority had received or were receiving treatment with systemic antimalarial and/or steroid preparations.Ocular examination of each patient included vwual acuity, slit-lamp biomicroscopy, ocular tension, fluorescein staining of the cornea, HRR cdlour testing, Amsler grid, and direct and indirect ophthalmoscopy.