Can Sweet’s syndrome affect the eyes?

Links checked on 29/03/17.

What are the symptoms of Sweet’s syndrome?

The main symptom of Sweet’s syndrome is skin lesions (Sweet’s lesions) that often appear as a sore or painful red or purple rash, but patients commonly develop other symptoms too.

Read more about symptoms here.

Can Sweet’s syndrome affect the eyes?

Yes. Sweet’s syndrome can affect the eyes in up to 72% of patients (Bilgin et al, 2015:54). Usually, only one eye will be affected, but it is possible for both eyes to be affected at the same time (Zhuang and Li, 2011).

What are the symptoms?

Initial symptoms often include:

  • Sore eyes.
  • Eye pain.
  • Blurry vision.

Other symptoms include:

  • Eye redness.
  • Dry eyes. Some eye problems caused by Sweet’s syndrome may also increase the risk of developing ‘dry eye syndrome’. However, this can happen for lots of different reasons that may not be related to Sweet’s syndrome (see ‘Further information’).
  • Eye watering.
  • Itching.
  • ‘Sticky’ eyes.
  • Sensitivity to light.

On rare occasions, eye symptoms may worsen, causing severe inflammation, tissue damage, ulceration, and vision loss.

Can Sweet’s syndrome affect the eyes even if skin lesions are not present?

Yes. It is possible to have Sweet’s syndrome-related eye problems even when skin lesions are not present, but this is not common (Bilgin et al, 2015:54; Koay et al, 2013).

What are the commonest eye problems?

Conjunctivitis, episcleritis, limbal nodules and iridocyclitis are the some of the commonest eye problems (Baartman et al, 2014:193).

What other eye problems can Sweet’s syndrome cause?

Other eye problems include:

  • Blepharitis (Cohen, 2007).
  • Choroiditis (Baartman et al, 2014:193).
  • Conjunctival erythematous lesions with tissue biopsy showing neutrophilic inflammation (Cohen, 2007).
  • Conjunctival haemorrhage.
  • Conjunctival nodules (Zhuang and Li, 2011).
  • Dacryoadenitis (Cohen, 2007).
  • Glaucoma (Bilgin et al, 2015:54; Cohen, 2007). This is rare in Sweet’s syndrome, and can also be caused by steroid medication.
  • Iritis (Cohen, 2007).
  • Ocular congestion.
  • Optic nerve involvement (Bilgin et al, 2015:54; Koay et al, 2013; Lobo et al, 2011).
  • Periocular cellulitis (cellulitis around the eyes), swelling around the eyes, lesions on the eyelid or around the eyes, or eye and eyelid inflammation (Bilgin et al, 2015:54; Cohen, 2007; Khatri and Taha, 2007; Morgan and Callen, 2001).
  • Peripheral ulcerative keratitis (Bilgin et al, 2015; Carbonell et al, 2011; Cohen, 2007). This is rare in Sweet’s syndrome, but can cause severe inflammation and tissue damage, potentially leading to visual impairment and blindness.
  • Retinal vasculitis (Baartman et al, 2014; Cohen, 2007). This is rare in Sweet’s syndrome, but more common in the similar condition Behcet’s syndrome. It can potentially lead to retinal ischaemia, visual impairment and blindness.
  • Scleritis (Bilgin et al, 2015; Carbonell et al, 2011; Cohen, 2007).
  • Uveitis and panuveitis (Bancu et al, 2016; Cohen, 2007; Lobo et al, 2011; Matsumiya et al, 2012; Stevenson and Hannay, 2016). This is rare in Sweet’s syndrome, but uveitis is the most common eye condition in those with Behcet’s syndrome.

How are eye problems caused by Sweet’s syndrome diagnosed?

  • A doctor will ask you about your symptoms.
  • Your eyes will be examined.
  • Sometimes other investigations are needed, e.g. CT scan (computerized tomography), or an eye biopsy.

Read more about diagnosis here.

How are eye problems treated?

Treatment includes systemic steroids and/or eye drops (usually steroid eye drops) depending on which part of the eye is affected or the severity of the eye condition. However, other medications may be given.

If the eyes are dry, lubricant eye drops, otherwise known as ‘artificial tears’ can be beneficial.

Read more about treatment here.

References.

Baartman, B., Kosari, P., Warren, C., Ali, S., Jorizzo, J., Sato, M. and Kurup, S. (2014) Sight-Threatening Ocular Manifestations of Acute Febrile Neutrophilic Dermatosis (Sweet’s Syndrome). Dermatology, Mar;228:193–197 (Karger).   

Bancu, L., Ureche, C., Craciun, N., and Marian, D. (2016) A case of Sweet’s syndrome associated with uveitis in a young male with ulcerative colitis. Romanian Journal of Morphology and Embryology, 57(3):1145-1147 (PubMed). In this case, the uveitis may be associated with the Sweet’s syndrome or ulcerative colitis.

Bilgin, A., Tavas P., Turkoglu, E., Ilhan, H., Toru, S. and Apaydin, K. (2015) An uncommon ocular manifestation of Sweet syndrome: peripheral ulcerative keratitis and nodular scleritis. Arquivos Brasileiros de Oftalmologia, Jan-Feb;78(1):53-5 (PDF).

Carbonell, D., Agdeppa, M. and Mejia, M. (2011) Peripheral Ulcerative Keratitis in Sweet’s Syndrome. Phillipine Journal of Ophthalmology, Jan-Jun; 36(1):46-49 (PDF).

Cohen, P. (2007) Extracutaneous Manifestations: Table 4. In Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis, Orphanet Journal of Rare Diseases (online). 

Khatri, M. and Taha. M. (2007) Sweet’s syndrome associated with myelodysplastic syndrome presenting as periorbital cellulitis. International Journal of Dermatology, May;46(5):496-9 (PubMed).

Koay, C., Chew, F., Chong, K. and Subrayan (2013) Compressive Optic Neuropathy. Indian Journal of Ophthalmology, Mar;61(3):140-141 (online).

Lobo, A., Stacy, R., Cestari, D., Stone, J., Jakobiec, F. and Sobrin, L. (2011) Optic nerve involvement with panuveitis in Sweet syndrome. Ocular Immunology and Inflammation, Jun;19(3):167-70 (PubMed).

Matsumiya, W., Kusuhara, S., Yamada, Y., Azumi, A. and Negi, A. (2012) Sweet’s syndrome with panuveitis resembling Behçet’s disease. Japanese Journal of Ophthalmology, May;56(3):268-72 (PubMed).

Morgan, K. and Callen, J. (2001) Sweet’s syndrome in acute myelogenous leukemia presenting as periorbital cellulitis with an infiltrate of leukemic cells. Journal of the American Academy of Dermatology, Oct;45(4):590-5 (PubMed).

Stevenson, R. and Hannay, J. (2016). Sweet’s syndrome: a rare extraintestinal manifestation of ulcerative colitis. BMJ Case Reports, May 11 (online).

Zhuang, Y. and Li, Y. (2011) Bilateral Conjunctival Nodules in Sweet’s Syndrome. Journal of Clinical Experimental Ophthalmology; 2:146 (online).

Further information.

Mayo Clinic (2016) Cataracts: Self- Management (online). Includes information on lifestyle and home remedies, and prevention. Updated August 2016, and accessed 29/03/17.

Neuro-Sweet’s disease: a neurological variant. This Sweet’s syndrome variant can sometimes affect vision.

Ngan, V. (2002) Behcet Disease (online). Accessed 29/03/17.

NHS Choices (2016) Dry Eye Syndrome (online). Updated 17/03/16, and accessed 29/03/17.

© 2012-2017 Sweet’s Syndrome UK

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