Introduction
SLE is an autoimmune condition that affects the connective tissues.
- It's main ocular manifestations include lupus associated retinopathy, choroidopathy, and neuro-ophthalmic conditions.
- It affects the optic nerve head in 1-4%
- 39% show CNS involvement
Dead Giveaways
Lupus-Associated Retinopathy:
Mild:
CWS, hard exudates, haemorrhages, vessel tortuosity
Moderate:
Arteriolar constriction, which can cause occlusions such as BRAO
Venous tortuosity
Severe:
Retinal vasculitis
Ischaemia
Neovascularisation
End Stage:
Proliferative retinopathy
Choroidal detachment
Notably, all features are not specific to SLE itself, but together can be used to define SLE
Roongta R et al. 2021, shows inferior vascular sheathing, and scattered CWS
Choroidopathy:
Multiple serous detachments of RPE and neurosensory retina.
Choroidopathy with retinal detachment 
Detachment also seen on OCT
Neuro-Ophthalmic Manifestations:
Presents with optic neuritis and optic neuropathy
Pupil abnormalities
Can show with retrochiasmal disease and associated conditions such as VF loss
diagnostic features
Symptoms:
Fatigue
Joint pain
Fever
Rash
Rashes which manifest may be around cheek area, or have lupus rashes manifest elsewhere
Anterior Eye Signs:
Dry eyes (Sjorgen's Syndrome)
Superficial punctate keratitis
Peripheral ulcerative keratitis
Anterior uveitis