What is your approach to the diagnosis and management of optic chiasmitis in systemic lupus erythematosus?

Optic nerve involvement occurs in SLE but not commonly. I am aware of two case reports about 20 years apart describing inflammation of the optic chiasm in lupus. Both appeared the Neuroophthalmology and the most recent was 16:117, 2020. I would be cautious about making the diagnosis of lupus if serology and chiasmitis were the only supporting features. The optic chiasm could be involved from other causes such as MS, MOG-associated disease, or infections.

In 1997 in the British Journal of Ophthalmology (81:130) my colleagues and I reported treating 3 patients with SLE and optic neuritis with intravenous cyclophosphamide with good results. Intravenous methylprednisolone should be considered in the acute management. Rituximab has been used succ...