Lupus with Optic Pallor?

A few weeks ago I had my first migraine which lasted 3 days. After that, my vision in my right eye was blurry. I went to my annual visit w/ my opthamologist and she noted optic pallor and that my right pupil was not responding to light well. I am going to a neuro-opthamologist next week for a 2 hour exam. My MRI of the brain came back clean. I have full bloodwork scheduled for 4/27.

About 2 yrs ago, I had a blood test which showed borderline positive for Lupus. Can there be an association between Lupus, optic pallor and the double blurred vision I am having? Or could this be something else? My concern is that it could be MS.

Thank you in advance for your response.

[Kevin Pho, MD]

Regarding MS, the sensitivity of an MRI is around 87 to 90 percent - meaning that if you had MS, the MRI would be positive 87 to 90 percent of the time.  Further tests can include evoked potentials (EP) which are used to detect abnormal CNS function that may be clinically undetectable as well as a lumbar puncture to evaluate the cerebrospinal fluid.

The eye is frequently involved in lupus with the most common manifestation being keratoconjunctivitis sicca (dryness of the conjunctiva and cornea).  Although it may be possible that blurred vision may be associated with lupus, this is a less common finding.  

Other causes of double vision can include the following:
    * Thyroid eye disease affecting the external eye muscles
    * Disease of the arteries supplying the brain
    * Diabetes
    * Stroke
    * Brain tumor
    * Aneurysm on the brain arteries  

You may want to discuss these possibilities with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Olek.  Diagnosis of multiple sclerosis.  UptoDate, 2004.

[AngelicBrat]

I have an afternote...

I have Optic nerve edema due to Antiphospholipid Syndrome and Lupus.  My Rheumatologist feels that the inflammation in both of my eyes (the nerves are inflamed and discs are pale) is from the Lupus and he feels that I may have a clot in my occipital lobe which is causing pressure on the eye.  I have double and blurred vision which has not improved.  The doctors here had tried to diagnose me with MS, but I dont have it!

Antiphospholipid Syndrome can mimik MS to a "T".  It causes many of the same symptoms as MS but patients with APS have a history of clots (leg clots, miscarraige (miscarriage), stroke, TIA's).  The symptoms that are associated with APS are: migraines/headaches, fatigue,  brain "fog", tingling/numbness in the extremities, dizziness, history of seizures, ringing in the ears, etc.  A patient with APS will feel very unwell and fatigued also.  The blood work to detect APS is the anticardiolipin antibody test and the Lupus anticoagulant.  If one or both are present, then a patient must be retested in 6 weeks to confirm the diagnosis.  Also, a patient can have APS in the absence of positive blood work.  They call it "Sero-Negative APS".  The treatment for APS is to thin the blood out because it is too "sticky" and clots too easily.  Treatment can consist of a junior aspirin a day or in patients with history of clots they will thin the blood out with Warfarin. Also, APS goes with Lupus hand in hand, and since you have symptoms of Lupus and blood work that is EXTREMELY positive (normal is generally under 1:40) then its worth getting checked for APS too.  APS can also occur as a primary condition too. Just thought I would add that.  

~Angelic