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LETTER
Year : 2013  |  Volume : 59  |  Issue : 3  |  Page : 245-246

Acute onset myopia as a presenting feature of systemic lupus erythematosus


1 Department of Ophthalmology, Kasturba Medical College, Manipal, Karnataka, India
2 Department of Dermatology, Kasturba Medical College, Manipal, Karnataka, India

Date of Web Publication12-Sep-2013

Correspondence Address:
Y S Kamath
Department of Ophthalmology, Kasturba Medical College, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.118060

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How to cite this article:
Kamath Y S, Singh A, Bhat S S, Sripathi H. Acute onset myopia as a presenting feature of systemic lupus erythematosus. J Postgrad Med 2013;59:245-6

How to cite this URL:
Kamath Y S, Singh A, Bhat S S, Sripathi H. Acute onset myopia as a presenting feature of systemic lupus erythematosus. J Postgrad Med [serial online] 2013 [cited 2019 Dec 8];59:245-6. Available from: http://www.jpgmonline.com/text.asp?2013/59/3/245/118060


Sir,

Systemic lupus erythematosus (SLE) is a multisystem immunological disorder with myriad ocular features. [1] We report a rare presentation of blurred vision due to acute myopia, with only few such cases reported in the literature. A 19-year-old female presented with symptoms of bilateral lid edema and blurred vision since 3 days. She gave a history of skin rashes on her forearms and face with intermittent fever and joint pain in the last 6 months. She denied taking any oral medications for her condition. There was no history of prior ocular disease or trauma. On examination, the visual acuity in oculi uterque (OU) was 20/20; N6 with a correction of − 4.25 D sphere. Intraocular pressure in both her eyes was 22 mmHg. There was a maculopapular rash over the malar region of face with bilateral lid edema and conjunctival chemosis [Figure 1]. Anterior chamber was quiet but shallow on gonioscopy. Anterior chamber depth by immersion A-scan ultrasonography in oculus dexter (OD) was 2.53 mm; oculus sinister (OS) was 2.46 mm. Fundus examination was normal except for retinal folds in the macula in OU [Figure 2]. B scan ultrasonography showed features of annular ciliochoroidal effusion and a "T"-sign suggestive of posterior scleritis [Figure 3]. She was started on topical prednisolone drops q 4 th hourly and homatropine eye drops q 8 th hourly in OU. A Dermatology opinion of the papular lesions with photoaggravation pointed toward systemic lupus erythematous (SLE). Her blood pressure was normal. Her hemoglobin was 9.3 g/dl; Erythrocyte sedimentation rate was 92 mm/1 h. Anti-nuclear antibody (global) was strongly positive. Renal function was normal apart from mild proteinuria. Histopathological and immunofluorescence studies confirmed SLE. She was added on systemic steroids and hydroxychloroquine.
Figure 1: Bilateral lid edema with malar rash

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Figure 2: Retinal striae

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Figure 3: Ocular ultrasound bscan showing early T sign

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On follow-up after 2 weeks, her unaided vision OU had improved to 20/20; N6, with an intraocular pressure of 9 mmHg and her lid edema had significantly decreased [Figure 4]. Anterior chamber had deepened with depth of OD: 3.77 mm; OS: 3.76 mm. B-scan showed a resolution of the anterior choroidal effusion and T sign.
Figure 4: At 1 month follow‑up: Resolved lid edema

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In SLE, diminution of vision may be secondary to keratoconjunctivitis sicca, posterior scleritis with retinal involvement, lupus retinopathy and choroidopathy and optic neuritis. [1] The presentation of SLE with acute myopia has been rarely reported.

Acute onset of myopia results either due to changes in the curvature or refractive index of the lens or the anterior shift of the iris lens diaphragm.

The anterior displacement of the iris lens diaphragm is seen in ciliochoroidal effusion, ocular blunt trauma and with the use of miotics like pilocarpine. Ciliochoroidal effusion has been attributed to posterior scleritis [2] and use of drugs including topiramate and hydrochlorothiazide. [3],[4]

In our patient, a negative drug history, refractive evaluation, supported by the shallow anterior chamber suggest acute onset myopia due to anterior displacement of the iris lens diaphragm, in turn due to posterior scleritis and ciliochoroidal effusion secondary to SLE.

Hung et al. have reported a patient with SLE in whom they have documented the forward rotation of the ciliary body as the cause for transient myopia, using ultrasound biomicroscopy. [5] However in our patient, due to technical reasons the same could not be done at presentation.

This case highlights an unusual presentation of a multisystem disorder and the role of ophthalmological evaluation in SLE.


 :: Acknowledgments Top


We would like to thank the Photography team of Department of Ophthalmology and the Heads of Departments of Ophthalmology and Dermatology.

 
 :: References Top

1.Palejwala NV, Walia HS, Yeh S. Ocular manifestations of systemic lupus erythematosus: A review of the literature. Autoimmune Dis 2012;2012:290898.  Back to cited text no. 1
    
2.Ikeda N, Ikeda T, Nomura C, Mimura O. Ciliochoroidal effusion syndrome associated with posterior scleritis. Jpn J Ophthalmol 2007;51:49-52.  Back to cited text no. 2
    
3.Bhattacharyya KB, Basu S. Acute myopia induced by topiramate: Report of a case and review of the literature. Neurol India 2005;53:108-9.  Back to cited text no. 3
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4.Roh YR, Woo SJ, Park KH. Acute-onset bilateral myopia and ciliochoroidal effusion induced by hydrochlorothiazide. Korean J Ophthalmol 2011;25:214-7.  Back to cited text no. 4
    
5.Hung KC, Hsueh PY, Wang NK, Su WW, Tan HY. Transient myopic shifting in systemic lupus erythematosus. Lupus 2011;20:334-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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