Ocular manifestations of Juvenile Systemic Lupus Erythematosus: a systematic review

Juvenile-onset Systemic Lupus Erythematosus (JSLE) is a chronic multifactorial autoimmune disease with multiple system involvement, affecting children and adolescents. Ocular manifestations are rare and can range from mild to severe. JSLE impacts quality of life and prognosis. However, the impact JSLE has on children's ocular health remains an underexplored area. This systematic review aims to consolidate existing evidence on ocular manifestations in JSLE. A systematic search of MEDLINE and ScienceDirect was conducted until October 2024. Eligible studies focused on children and adolescents with JSLE presenting ocular symptoms. Joanna Briggs Institute critical appraisal tools for each study were employed for quality assessment. Forty-two studies evaluating ocular manifestations in JSLE patients were included. Among those were 29 case reports and case series with 34 patients in total, 4 cross-sectional studies, with a total of 210 patients, 155 of whom had ocular manifestations, and 9 cohort studies, with a total of 2696 patients enrolled and 212 of them reporting ocular manifestations (7.8%). Results were categorized by affected ocular structures: external, anterior, or posterior segment. Neuro-ophthalmological and drug-induced manifestations were described separately. Retinal involvement was the most often reported. Notable manifestations included dry eye disease, uveitis, vaso-occlusive retinopathy, and corticosteroid-induced cataracts. Ocular symptoms often served as the initial indication of disease onset. Heightened awareness and standardized assessments are necessary for management of ocular manifestations. Further research is needed to comprehensively elucidate the underlying mechanisms and pathogenesis of the disease.