Ophthalmological manifestations in autoimmune diseases: Overcoming diagnostic and therapeutic challenges

Figure 1 Blood-ocular barrier maintains the immune-privileged status of the eye by restricting the entry of blood-borne substances. It consists of two main components: The inner blood-retinal barrier formed by tight junctions between retinal endothelial cells and supported by Müller glial cells, which regulate fluid and ion balance and the outer blood-retinal barrier composed of tight junctions between retinal pigment epithelial cells adjacent to the choroid, controlling molecular exchange between the retina and the systemic circulation.

Figure 2 Anatomy of the human eye and locations of the most common manifestations of autoimmune diseases that affect the eye.

Figure 3 Diagnostic algorithm for systemic work-up in patients with vision loss suspected of an autoimmune etiology. ON: Optical neuritis; SS: Sjögren's syndrome; RA: Rheumatoid arthritis; MS: Multiple sclerosis; KCS: Keratoconjunctivitis sicca; SLE: Systemic lupus erythematosus; ANA: Anti-nuclear antibodies; RF: Rheumatoid factor; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; ACE: Angiotensin converting enzyme; HLA: Human leukocyte antigen.