Lupus- the symptoms and diagnos

Some medications used to treat lupus can themselves THE LUPUS UK RANGE
contribute to eye problems. Steroids, particularly if usedat high doses over a long period, increase the risk of The Mouth,
developing cataracts at an earlier age than other people OF FACT SHEETS
not on such drugs. Also patients taking steroids are atincreased risk of optic nerve damage from raised A range of fact sheets are available as follows:
Nose and Eyes
pressure in the eye (“glaucoma”). Regular eye checkswith an optician wil general y pick up on such problems 1. LUPUS Incidence within the Community
at an early stage and treatment for these conditions can 2. LUPUS A Guide for Patients
be recommended by an ophthalmologist. In the past 3. LUPUS The Symptoms and Diagnosis
antimalarial medications caused some concerns due to 4. LUPUS The Joints and Muscles
complications that could affect the vision (retinopathy), 5. LUPUS The Skin and Hair
particularly with chloroquine. This is much less of a 6. LUPUS Fatigue and your Lifestyle
problem these days, due to the use of lower dosagesand with the preference for hydroxychloroquine overchloroquine. However if you notice a deterioration inyour reading vision or your perception of colour youshould mention it to your doctor and attend youroptician for an eye check in the first instance. Thecommonest reasons for changes in vision are age-related changes in focusing (which can be overcome byappropriate glasses) or cataracts, rather than sideeffects from hydroxychloroquine.
US and Pregna C
8. LUPUS and Blood Disorders
9. LUPUS and Medication
10. LUPUS and the Kidneys
11. LUPUS and Associated Conditions
12. LUPUS and the Brain
13. LUPUS The Heart and Lungs
14. LUPUS The Mouth, Nose and Eyes
15. LUPUS and Light Sensitivity
What are the key messages to bear
UPUS and E
17. LUPUS and Men
18. LUPUS and Mixed C E
onnective T
LUPUS UK is the registered national charity caring for peoplewith presently incurable lupus and has over 6,000 memberswho are supported by the Regional Groups.
Mouth and eye problems are common in lupus, butmost of the time is irritating rather than serious. Most LUPUS UK acknowledges with gratitude the assistance of cases of mouth ulcers, dry mouth and dry eyes respond Dr Alastair Denniston (Birmingham and Midland Eye Centre, to fairly simple treatments. However a sudden new Birmingham) and Prof. Caroline Gordon (Queen Elizabeth problem such as severe eye pain or decreased vision Hospital and City Hospital, Birmingham) in the provision of requires urgent attention from an eye specialist, usual y clinical information towards the production of this fact sheet.
via an Eye Casualty service, your own GP or even theout-of-hours GP service. You should also keep your LUPUS UK also thanks the Wooler Walkers (Northumberland) lupus specialist informed of what is happening so that for their valued sponsorship towards the cost of producing the they can help keep a look out for other signs of a flare and adjust your general treatment as necessary.
Please contact our National Office should you require furtherinformation about lupus. LUPUS UK will be pleased to providea booklist and details of membership.
TEL: 01708 731251
www.lupusuk.org.uk
seen in people with lupus which is more limited to the There is a wide range of eye drops available. They skin. Again teeth brushing, flossing and giving up range from watery drops like hypromel ose, which are smoking should be priorities. Depending on the type convenient, but the effects of hypromel ose eye drops The Mouth,
of lesion, steroid paste may be used, coupled with do not last very long. To overcome this problem thick antimalarial tablets such as hydroxychloroquine.
paraffins may be recommended as they are long People with discoid lupus sometimes worry about the lasting but they may blur the vision. Gels such as Nose and Eyes
reported increased risk of these lesions becoming carbomer lie somewhere in between. Gels and most cancerous. It should however be borne in mind that watery drops usual y contain preservatives, which can this is very unusual, only applies to the most extreme cause irritation. If this is a problem then a preservative- cases and that anybody with such severe disease free equivalent should be used. Mild dry-eye may only would be closely watched by their specialist.
ow can lupus affect the mouth
require the use of a watery drop or gel a few times aday, which can be increased as required. However and nose?
Having a chronic condition such as lupus may put you more severe dry-eye wil require frequent use of a at slightly increased risk of some other conditions combination of drops e.g. frequent gel by day with a such as cold sores and thrush of the mouth. Thrush is paraffin at night. Other drops sometimes used in One of the most common features of lupus is mouth also more common when receiving antibiotics or ulcers. This often occurs during flares of the disease, certain specialist drugs, such as cyclophosphamide and may be associated with joint pains, rashes and hair infusions, so to avoid this complication anti-thrush loss. Fortunately when the disease settles, the mouth treatments are given where necessary as a ulcers settle as wel in most people, although stress or As wel as giving replacement tears we can try to tiredness can make the mouth ulcers worse. Mouth preserve the natural tears by blocking the tear ducts ulcers can be painful and uncomfortable. If they are an with either temporary or permanent plugs. The ongoing problem simple treatments such as antiseptic decision to use these has to be made by an mouthwashes can be helpful, and sometimes steroid ophthalmologist. These plugs are often extremely lozenges or paste are necessary. Occasional y the nose Why do my eyes feel dry?
effective but may need to be used in conjunction with can also be similarly affected and is treated with Vaseline cream or, in more severe cases, steroid pasteor nasal spray. In the vast majority of people these Around a third of people with lupus have some sort of simple measures coupled with good control of the eye problem related to their disease. Fortunately in How else can lupus affect the eyes?
disease are al that is necessary. In the rare cases where most people only the surface of the eye is affected.
ulceration of the mouth or nose is more severe then This does not damage their vision and is readily more specialist drugs may be required, such as treated with eye-drops. Much less commonly the Other eye-related problems are much less common; disease may involve the inside of the eye or the visual although they should be taken seriously as they may pathways in the brain. This may reduce vision and be painful or may affect eyesight. Lupus can cause Don’t forget that there are things you can do to help.
usual y requires systemic treatment, either by oral or inflammation of the white coat of the eye (“scleritis”), Keeping your teeth properly brushed and flossed, and intravenous routes. In this section, we wil consider the which may be very painful and is usual y visible as a giving up smoking and avoiding spices is even more different ways lupus can affect the eyes and the types bright red patch on part or al of the white of the eye.
important in people who have lupus than those that do This is a more serious condition than conjunctivitis, not. If the mouth is particularly sore consider using a which is more common and is usual y due to infection.
By far the commonest problem is dry eyes, usual y as Conjunctivitis is irritating rather than very painful and part of Sjogren’s syndrome. In Sjogren’s syndrome may be associated with a sticky discharge.
inflammation of the tear (lacrimal) glands results in Occasional y there is inflammation at the back of the fewer and poorer quality tears. This makes the eyes an the lupus skin rashes spread
eye either of the retina (“retinopathy”) or of the main feel gritty, dry and they may look red. Although this nerve (“optic neuropathy”), either of which may affect inside the mouth?
may vary in severity, ‘dry-eye’ is general y a problem one’s eyesight. Rarely the nerves to the muscles that that requires long-term treatment with artificial tears move the eyes can be affected causing double vision.
(eye-drops). Milder cases are usually effectively Some people with lupus can develop raised red areas For this reason any severe eye-pain, loss of vision or managed by the GP although more severe cases may of skin known as “discoid” lesions. If similar discoid double vision should be reported to your doctor require additional advice from an ophthalmologist (eye lesions do occur in the mouth or nose, they can urgently. Treatment may require steroids, or other specialist). Sjogren’s syndrome commonly affects the occasional y breakdown the lining to form an ulcer. This immunosuppressive medications once infection has salivary glands causing the mouth to be dry as wel .
is rare in people with systemic lupus, but is sometimes

Source: http://www.lupusuk.org.uk/images/pdf/14lupusmouthnoseeyes.pdf