Eye movement abnormalities in systemic lupus erythematosus

To describe eye movement abnormalities in patients with systemic lupus erythematosus (SLE).

Between January 1, 1970, and June 30, 1995, 113 patients with a clinical diagnosis of SLE were examined. Of these, 33 had ocular motor abnormalities and a diagnosis of SLE as defined by the revised criteria of the American College of Rheumatology.

Patients hospitalized on the wards of the Los Angeles County-University of Southern California Medical Center, Los Angeles.

Thirty-three patients, 82% women, ranging in age from 19 to 58 years (mean, 33.5 years). The average duration of SLE was 3.5 years, and 10 patients had been symptomatic for 5 years or longer.

Of 55 ocular motor signs, 33 involved limitation of eye movements or abnormal eye position at rest; abnormal spontaneous eye movements occurred 12 times; ptosis was seen in eight patients and psychogenic signs in two. Sixteen patients (48%) had brain-stem infarcts; 11 had other known causes, including three with meningitis, two with hysteria, and one each with ocular myositis, pseudotumor cerebri, both ocular myositis and pseudotumor cerebri, Guillain-Barré syndrome, hyperosmolality, and hypoxic encephalopathy. In four patients with isolated sixth nerve palsies and two with isolated ptosis, the cause remained unknown.

Ocular motor signs in SLE are uncommon and often transitory. When present, they help to ascertain the location, and often the cause, of neurologic involvement.