Abstract
Purpose
To describe ocular findings, including dry eye disease (DED) and evaluation of hydroxychloroquine (HCQ) retinal toxicity, in Juvenile Systemic Lupus Erythematosus (JSLE) patients followed in a Brazilian referral tertiary-care center.
Methods
This cross-sectional study included 46 JSLE patients under 18 years of age, consecutively recruited between 2020 and 2023, from two university centers. Ophthalmological evaluations included best-corrected visual acuity, tear film break-up time (BUT), Schirmer test, anterior biomicroscopy with fluorescein staining using van Bijsterveld scores, applanation tonometry, fundus examination, and Spectral-Domain Optical Coherence Tomography (SD-OCT). DED was defined using the 2006 Japanese Dry Eye Society criteria and the ocular Sjögren’s syndrome criteria for dry eye. Associations between clinical, laboratory, and ocular findings were analyzed.
Results
Of the 46 patients (84.8% female; median age: 10 years), 76.1% met DED criteria, with 21.7% showing Schirmer test abnormalities (<10 mm). BUT <5 seconds was identified in 76%, and 45.65% had abnormal fluorescein staining. Only 8.7% reported symptoms of dry eye. No significant retinal abnormalities were detected on SD-OCT related to HCQ toxicity. The median HCQ cumulative dose was 204 g and the median time of its use was 2 years. A significant association between mycophenolate use and DED was identified (p = .041). No correlation was found between DED and antibody levels, complement levels, or corticosteroid use.
Conclusion
DED is highly prevalent and frequently asymptomatic in pediatric JSLE patients, emphasizing the need for routine ophthalmologic evaluations. The absence of SD-OCT abnormalities in this cohort aligns with low HCQ exposure, but further studies are needed to validate current adult-based screening guidelines in children.
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