Ocular manifestations of systemic lupus erythematosus in children

OBJECTIVE: To determine the prevalence and spectrum of ocular manifestations in children with systemic lupus erythematosus (SLE) and to examine the correlation of the ocular manifestations with disease activity, other organ involvement and the presence of circulating autoantibodies.

METHODS: In this cross-sectional study, we performed at King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia from June 2000 to November 2002, a comprehensive evaluation including detailed eye examination, measuring circulating autoantibodies (antinuclear, antiphospholipid antibodies) and calculation of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).

RESULTS: Fifty-two consecutive children (45 females) with SLE completed the evaluation. The mean age of the patients was 11.3 years and the mean SLEDAI was 9.5. Thirty patients (57.7%) had the disease for more than one year. Eighteen patients (34.6%) had ocular manifestations. Seven patients had abnormal Schirmer s test (2 bilateral, 5 unilateral). Five patients had (4 unilateral, one bilateral) retinal vascular lesions. One patient had bilateral iridocyclitis. Three patients had unilateral optic neuropathy and 11 patients had visual field defects (4 bilateral, 7 unilateral). Fisher exact test revealed positive correlation between optic neuropathy and central nervous system (CNS) involvement (p<0.002). There was no correlation among other variables; probably due to the sample size.

CONCLUSION: Ocular manifestations including sight threatening complications are not rare in children with SLE. Optic neuropathy has strong prediction for CNS lupus.