The Importance of Ophthalmological Examination in Erythematous Lupus: A Case Report and Literature Review

Abstract

Objective: Underline the importance of ophthalmological clinical examination in the management of Lupus. Case Report: A 25-year-old female with no previous medical history presented 15 days ago with erythematous, non-itchy, scaly maculo-papular lesions of the face in the form of a butterfly's wing, evolving in a febrile context with altered general condition, constipation and memory problems. The diagnosis of systemic lupus erythematosus was made on the basis of the clinical symptoms, biological results and the biopsy. Treatment was based on a synthetic antimalarial agent. An ophthalmological opinion was sought with a view to the introduction of synthetic antimalarials. Clinical examination revealed corrected visual acuity of 10/10 in the right eye and 10/10 in the left. Biomicroscopy of both eyes showed infiltration of the lower eyelids, and examination of the retina revealed diffuse cotton wool spots around the vessels, a sharply excavated papilla rated 0.4 on the right and 0.3 on the left, good-caliber vessels without vascular sheathing, and good macular reflexion. Fluorescein angiography of both eyes showed no signs of retinal ischaemia (at the posterior pole and retinal periphery) or diffusion at any time during the examination.  The patient was treated with hydroxychloroquine, dermocorticoids and local care for the skin lesions. The first month was marked by an improvement in skin signs, with stabilisation of the cotton wool spots on the fundus. However, dry keratoconjunctivitis appeared, leading to the prescription of a wetting agent and a vitamin A-based healing agent.