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December 1995

Eye Movement Abnormalities in Systemic Lupus Erythematosus

Author Affiliations

From the Department of Neurology, Los Angeles County—University of Southern California Medical Center, Los Angeles.

Arch Neurol. 1995;52(12):1145-1149. doi:10.1001/archneur.1995.00540360023011

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

Design:  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.

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

Subjects:  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.

Results:  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 brainstem 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.

Conclusions:  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.