Understanding the Link Between Lupus and Dry Eye
Systemic lupus erythematosus, commonly called lupus or SLE, is a chronic autoimmune disease. In autoimmune conditions, the immune system mistakenly attacks the body's own healthy tissues instead of protecting them from outside threats. Lupus can affect nearly every organ system, including the skin, joints, kidneys, heart, lungs, and eyes.
Lupus is more common in women than men and often develops during the childbearing years. The disease tends to follow an unpredictable pattern of flares, when symptoms get worse, and periods of remission, when symptoms improve. Because lupus affects so many parts of the body, it is often managed by a team of specialists working together.
One of the most significant ways lupus affects the eyes is by damaging the lacrimal glands. These are the small glands located above each eye that produce the watery portion of your tears. In lupus, the immune system creates proteins called autoantibodies that target these glands. Inflammatory cells then move into the gland tissue, causing damage and fibrosis (a type of internal scarring). Over time, this scarring reduces the gland's ability to make tears.
The result is a condition known as aqueous deficient dry eye. This means the eye does not produce enough of the watery layer of the tear film to keep the surface of the eye moist and comfortable. This type of dry eye is often more severe than the dry eye caused by screen use or environmental factors alone.
Many people with lupus develop a related condition called secondary Sjogren's syndrome. Sjogren's syndrome (pronounced SHOW-grins) is another autoimmune disorder that specifically targets the moisture-producing glands of the body. When it develops alongside lupus, it is called 'secondary' because it occurs as a result of the underlying lupus.
Secondary Sjogren's syndrome makes dry eye even more severe because it adds a second layer of immune attack on the lacrimal glands. People with both conditions often experience very low tear production, persistent eye discomfort, and dryness of other areas like the mouth. The TFOS DEWS III report, a major international research review on dry eye, identifies lupus as one of the leading systemic autoimmune causes of this type of profound dry eye.
Lupus does not only affect the tear glands. The widespread, systemic inflammation that defines lupus can also impact the blood vessels in and around the eye. Some lupus patients develop episcleritis or scleritis. Episcleritis is inflammation of the thin tissue covering the white of the eye, while scleritis is a deeper, more serious inflammation of the white of the eye itself.
These inflammatory conditions can cause redness, pain, and sensitivity to light. When combined with reduced tear production, the ocular surface becomes highly vulnerable. The tear film that remains tends to become hyperosmolar, meaning it has a higher salt concentration than normal. This concentrated tear film irritates the delicate cells on the surface of the cornea, leading to a cycle of damage and discomfort.
Dry eye caused by lupus differs from many other forms of the condition because it is driven by a deep, systemic immune response rather than a local problem in the eye alone. The underlying disease process is ongoing, which means the dry eye tends to be chronic and progressive without proper treatment. Over-the-counter artificial tears, while helpful for mild dry eye in otherwise healthy individuals, are usually not enough to control lupus-related dry eye on their own.
People with lupus-related dry eye often need a combination of treatments that address both the local symptoms on the eye surface and the underlying immune activity. This is why a team-based approach to care is so important.
Symptoms and Diagnosis of Lupus-Related Dry Eye
Dry eye caused by lupus can produce a wide range of symptoms that affect daily comfort and quality of life. Because the condition tends to be more severe than typical dry eye, symptoms may be persistent and difficult to ignore.
Common symptoms include:
- A persistent feeling of grittiness or sand in the eyes
- Burning or stinging sensations that worsen throughout the day
- Redness that does not go away with rest
- Blurred vision that temporarily improves with blinking
- Excessive tearing as the eye tries to compensate for dryness
- Sensitivity to light, especially in bright environments
- Difficulty wearing contact lenses comfortably
- Eye fatigue during reading, screen use, or driving
While many people experience occasional dry eye, lupus patients should be aware that their dry eye may signal deeper inflammation. Sudden increases in pain, significant redness, or noticeable changes in vision could indicate scleritis or corneal damage. These situations call for prompt evaluation by an eye care professional.
Lupus-related dry eye can also cause damage to the cornea, the clear front surface of the eye. When the cornea does not receive adequate moisture, tiny breaks or erosions can develop on its surface. Left untreated, these corneal changes can lead to chronic pain and reduced vision.
Diagnosing dry eye in someone with lupus involves a thorough eye examination. Your eye care provider will look at the overall health of the eye surface, measure tear production, and assess the quality of the tear film.
One common test is the Schirmer's test, which uses a small strip of paper placed gently under the lower eyelid to measure how much moisture the eye produces over a set period. Low scores on this test indicate reduced tear production. Your provider may also measure tear breakup time to see how quickly the tear film becomes unstable after a blink.
Additional assessments may include examining the cornea with special dyes that highlight areas of damage. Because lupus-related dry eye is closely tied to the systemic disease, your eye care provider may also coordinate with your rheumatologist (the doctor who manages your lupus) to get a full picture of your disease activity.
If you have lupus, regular comprehensive eye exams are essential. Dry eye and other ocular complications can develop gradually, sometimes before you notice significant symptoms. Early detection allows for earlier treatment, which can help protect the surface of the eye and maintain long-term comfort.
At Washington Eye Institute, our multidisciplinary ophthalmology and optometry team provides thorough evaluations for patients with autoimmune-related dry eye. Comprehensive eye exams allow us to monitor changes over time and adjust your care plan as needed.
Treatment Options for Lupus-Related Dry Eye
Even though lupus-related dry eye typically requires more than basic over-the-counter drops, supportive measures still play an important role in your overall comfort. Preservative-free artificial tears can help supplement moisture throughout the day. Avoiding preservatives is especially important for lupus patients who use drops frequently, as preservatives can irritate an already sensitive eye surface.
Environmental adjustments can also help reduce symptoms:
- Using a humidifier at home, especially during winter months
- Wearing wraparound sunglasses outdoors to reduce wind exposure
- Taking regular breaks during screen use to blink more often
- Staying well hydrated throughout the day
Because lupus-related dry eye involves significant inflammation, treatment often moves beyond over-the-counter options relatively quickly. Prescription topical immunomodulators are medications applied directly to the eye that help calm the immune response on the ocular surface. Cyclosporine and lifitegrast are two commonly prescribed options. These medications work by reducing the inflammatory activity that damages the tear-producing cells and the eye surface itself.
Short courses of topical corticosteroids (anti-inflammatory eye drops) may also be used during flares to quickly reduce acute inflammation. These are typically prescribed for limited periods because long-term steroid use on the eye can have side effects. Your eye care provider will carefully manage the timing and duration of any steroid treatment.
For patients with severe ocular surface damage, autologous serum drops may be recommended. These are custom eye drops made from a patient's own blood. The blood is drawn, processed to separate the serum, and then diluted to create drops that contain natural growth factors and nutrients. These drops can help heal damaged corneal tissue and provide relief that standard drops cannot match.
Punctal plugs are another option that can help lupus patients retain more of their natural tears. These tiny devices are placed in the tear drainage openings (called puncta) at the inner corners of the eyelids. By partially blocking tear drainage, punctal plugs help tears stay on the eye surface longer, improving moisture and comfort. Washington Eye Institute offers punctal plug placement as part of our dry eye treatment services.
Treating lupus-related dry eye effectively requires coordination between your eye care team and the specialists managing your lupus. Your rheumatologist plays a central role in controlling the systemic inflammation that drives the eye problems. When lupus is well managed overall, the ocular symptoms often improve as well.
This team-based approach is emphasized in the TFOS DEWS III guidelines, which note that managing autoimmune dry eye requires addressing the root cause of the inflammation, not just the symptoms on the eye surface. At Washington Eye Institute, our multidisciplinary ophthalmology and optometry team works collaboratively to provide coordinated care for patients with complex conditions like lupus.
Lupus-related dry eye is a chronic condition that requires ongoing management. With appropriate treatment, many patients experience meaningful improvements in comfort and eye health. However, because lupus itself follows a pattern of flares and remission, your dry eye symptoms may also fluctuate over time.
Regular follow-up appointments allow your care team to track your progress, identify flares early, and adjust treatment as needed. Being proactive about your eye health is one of the best things you can do to protect your vision and comfort for the long term.
Living With Lupus-Related Dry Eye
Managing lupus-related dry eye is not only about medical treatments. Daily habits can make a meaningful difference in how your eyes feel. Building a consistent eye care routine helps support your treatment plan and can reduce the frequency of uncomfortable flares.
Helpful daily practices include:
- Applying preservative-free artificial tears on a regular schedule rather than waiting for symptoms to become severe
- Practicing the 20-20-20 rule during screen time. Every 20 minutes, look at something 20 feet away for 20 seconds
- Keeping your eyelids clean with gentle lid hygiene
- Getting adequate sleep, as rest supports the body's natural healing processes
- Avoiding direct airflow from fans, heaters, or air conditioning vents on your face
Open communication with your doctors is essential when managing lupus-related dry eye. Let your eye care provider know about any changes in your lupus activity, new medications you have started, or shifts in your symptoms. Similarly, keep your rheumatologist informed about your eye health.
Keeping a simple symptom diary can be helpful. Note when your eyes feel worse, what activities seem to trigger discomfort, and how your symptoms relate to lupus flares. This information helps your care team make more informed decisions about your treatment plan.
Living with a chronic condition that affects your eyes can be emotionally challenging. Dry eye discomfort can interfere with work, hobbies, and social activities. It is completely normal to feel frustrated or overwhelmed at times.
Speaking with your care team about how your symptoms affect your daily life can help them tailor your treatment more effectively. Many patients find that having a clear treatment plan and a supportive care team makes a significant difference in their overall well-being.
While routine dry eye symptoms can typically be managed at regular appointments, certain changes warrant prompt attention. Contact your eye care provider if you experience a sudden increase in eye pain, significant new redness, noticeable changes in vision, or discharge from the eye. These symptoms could indicate a flare of scleritis, a corneal infection, or other complications that need timely evaluation.
Frequently Asked Questions
Lupus-related dry eye is a chronic condition tied to the underlying autoimmune disease. While treatment can significantly improve symptoms and protect the eye surface, the condition typically requires ongoing management. Controlling lupus activity through coordination with your rheumatologist is one of the most important steps in managing ocular symptoms over the long term.
Lupus-related dry eye is caused by immune system damage to the tear-producing glands, which leads to significantly reduced tear production. This is different from the more common forms of dry eye that are often related to screen use, aging, or environmental conditions. Lupus-related dry eye tends to be more severe and typically requires prescription treatments rather than over-the-counter drops alone.
Yes. Because lupus-related dry eye is driven by systemic inflammation, managing it effectively requires both a rheumatologist to address the underlying disease and an eye care team to treat the ocular symptoms. The TFOS DEWS III guidelines specifically recommend this multidisciplinary approach for autoimmune-related dry eye conditions.
Preservative-free artificial tears are generally recommended for people with lupus-related dry eye. Because these patients often need to use drops multiple times throughout the day, avoiding preservatives helps prevent additional irritation to the already compromised eye surface. Your eye care provider can recommend specific preservative-free options suited to your needs.
Punctal plugs are very small devices placed in the tiny drainage openings at the inner corners of the eyelids. They work by slowing the drainage of tears from the eye surface, which helps your natural tears stay on the eye longer. For lupus patients who produce fewer tears than normal, this can meaningfully improve moisture levels and reduce discomfort. The procedure to place punctal plugs is quick and performed in the office.
Regular comprehensive eye exams are important for anyone with lupus, even if you are not currently experiencing eye symptoms. Your eye care provider can recommend an exam schedule based on your individual situation, but many lupus patients benefit from being seen at least once or twice a year. More frequent visits may be needed during active lupus flares or if you are experiencing worsening eye symptoms.