Ophthalmic manifestations of systemic lupus erythematosus at a quaternary children's hospital.

PURPOSE: To describe the ophthalmic manifestations and visual outcomes of pediatric systemic lupus erythematosus (SLE) and its commonly used medications, including hydroxychloroquine and corticosteroids.

METHODS

The charts of all pediatric patients (<21 years of age) treated for SLE between December 2000 and May 2024 at a quaternary children's hospital were retrospectively reviewed. Patient demographics, rheumatology and ophthalmology examinations, and treatments were collected. Outcomes included ophthalmic manifestations, visual acuity, and hydroxychloroquine toxicity screening results.

RESULTS

A total of 180 patients were included (87% female). Mean age at presentation was 13.4 ± 3.4 years (range, 3-20), and mean age of SLE diagnosis was 13.5 ± 3.6 years. Of these patients, 84 were evaluated by ophthalmology, and 33 (39%) had one or more ocular manifestations related to SLE or SLE medications, most commonly retinal vascular changes or lesions (n = 8), papilledema (n = 6), hydroxychloroquine toxicity (n = 6), cataracts (n = 5), and dry eye (n = 5). Twenty-six patients had ocular manifestation(s) of SLE and long-term ophthalmology follow-up: initial best-corrected visual acuity of the worse-seeing eye was logMAR 0.05 ± 0.13; final, logMAR 0.01 ± 0.09. Of the remaining patients, 92 not evaluated by our ophthalmology department were using hydroxychloroquine, of whom 29 (32%) had no mention of undergoing hydroxychloroquine toxicity screening at other institutions.

CONCLUSIONS

There is a substantial burden of ophthalmic disease in pediatric SLE, albeit with good visual outcomes. Pediatric patients should receive prompt baseline ophthalmic examination at SLE diagnosis and routine screening thereafter.