Purpose
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder affecting multiple organ systems frequently with a relapsing and remitting clinical course. It may have ocular manifestations at posterior pole, cornea, conjunctiva, sclera, uveal tract and optic nerve.
SLE is a complex disease with dysregulation of the immune system with defects in the innate and adaptive immune systems.
Methods
A 40‐year‐old Spanish woman was diagnosed with SLE 5 years before. At the time she underwent treatment with a tapering dose of oral prednisone (currently 10 mg/day) and hydroxychloroquine because of a relapse only with cutaneous involvement. She came to the emergency department because she noticed a nasal visual field defect and flashes in her right eye. Her best corrected visual acuity (BCVA) was 20/20 in both eyes and slit‐lamp anterior segment examination was unremarkable. Right fundus showed multiple cotton wool spots along the vessels, and some intraretinal haemorrhages in the inferior temporal branch retinal.Right fundus fluorescein angiography revealed an active vasculitis with abnormal vessel permeability and leakage of the dye together with a branch retinal artery occlusion along the inferotemporal arcade without ischemic areas. Her left eye was normal. She was treated with high‐dose steroid (intravenous methylprednisolone 500 mg/day during 3 days). Then, she completed 2 doses of intravenous cyclophosphamide 400 mg and oral prednisone (45 mg/day) and hydroxychloroquine 400 mg/day.
Results
The following week the fundus examination demonstrated resolution of haemorrhages without neovascularization or cotton wool spots. BCVA remained 20/20 and visual field exam slightly improved.
Conclusions
SLE may lead to severe unilateral vasculitis. However, an early diagnosis and aggressive treatment allow the resolution of the disease without many sequelae.