How Do Autoimmune Diseases Affect the Retina?

Imagine your immune system as a powerful security team, constantly patrolling and defending against threats. Normally, it identifies and neutralizes harmful invaders like bacteria or viruses, but sometimes, that protective system goes awry. Instead of targeting threats, it mistakes your body’s healthy tissues as enemies. When this “friendly fire” affects the delicate structures of your eyes—particularly the retina—it can trigger inflammation, cause cellular damage and lead to serious vision issues. With over 80 autoimmune disorders identified, many have the potential to impact your retinal health in ways you may not realize.

Several autoimmune diseases can affect the retina, often leading to inflammation and damage to the ocular tissues. Vision loss, blurry vision, light sensitivity, flashes and floaters, color distortion, elevated intraocular pressure associated with retinal conditions like uveitis and glaucoma, cataract formation, and potential blindness are consequences of chronic inflammation perpetuated by autoimmune diseases on the retina. Systemic lupus erythematosus (SLE), multiple sclerosis (MS), Behcet’s diseases, Vogt-Koyanagi-Harada disease, sarcoidosis, autoimmune retinopathy and Grave’s disease are key conditions that impact the retina. These autoimmune diseases affect the retina in several ways:

• Immune Response: The body produces autoantibodies, which are antibodies that mistakenly attack healthy cells. When these autoantibodies are directed at retinal components, they trigger inflammatory responses that can damage retinal cells and structures. Activated immune cells release pro-inflammatory cytokines and other mediators that exacerbate inflammation in the retina. This leads to conditions such as uveitis (inflammation of the uveal tract) and retinitis (inflammation of the retina), causing swelling, pain and visual disturbances. T-cells, a type of white blood cell, may become activated against retinal antigens. These cells can infiltrate ocular tissues, contributing to chronic inflammation and tissue damage, leading to a cycle of worsening symptoms.

• Vascular Complications: In conditions like lupus and Behcet’s disease, the inflammation of the retinal blood vessels can restrict blood flow, leading to a condition known as retinal ischemia. Ischemia deprives retinal cells of oxygen and essential nutrients, leading to cellular dysfunction and death. In autoimmune diseases like multiple sclerosis, inflammation can also compromise the blood-brain barrier. This not only affects the central nervous system but can also alter the blood-retinal barrier, resulting in leakage of fluid and immune cells into the retina, causing edema and damage. In response to ischemia, the retina may attempt to compensate by forming new blood vessels (neovascularization). However, these new vessels are often fragile and can lead to bleeding and further complications like proliferative diabetic retinopathy.

• Cellular Damage: The immune system’s attack on retinal cells can induce apoptosis (programmed cell death), leading to a loss of crucial photoreceptors (rods and cones) responsible for light detection and color vision. Loss of these cells severely impacts visual function. The presence of inflammatory cells in the retina can disrupt the normal function of retinal cells leading to alterations in signal transmission and further contributing to visual impairment. Retinal Pigment Epithelium damage plays a superior role in supporting photoreceptors and maintaining the blood-retinal barrier. In autoimmune conditions, the immune attack can lead to RPE dysfunction, causing retinal detachment and other visual disturbances.
• Systemic Effects: The systemic inflammatory state characteristic of many autoimmune diseases can lead to generalized immune activation. This can increase the likelihood of inflammation in the eyes, resulting in ocular complications. Some autoimmune diseases involve antibodies that may cross-react with similar antigens found in the retina, exacerbating ocular inflammation. Damage to other organs or systems, such as the thyroid in Graves’ disease, can influence eye health. For instance, increased thyroid hormones can lead to eye muscle inflammation, impacting the alignment and movement of the eyes, which may indirectly affect visual perception.

While the exact causes of autoimmune diseases aren’t fully understood, genetic factors, environmental triggers, infections and certain medications are believed to play a role in their development. For this reason and more, it is critical to include retinal imaging as part of an annual comprehensive eye exam. Scheduled yours with Associated Retina Consultants at 602-242-4928 or WEBSITE.