How SM can affect your eyes and vision: symptoms and care

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Systemic mastocytosis (SM) rarely affects the eyes, but if it does, it can lead to loss of vision.

Systemic mastocytosis (SM) rarely affects the eyes, but if it does, it can lead to loss of vision.

When it does occur, it is usually following disease progression to a more serious form of SM, notably aggressive systemic mastocytosis (ASM). Often referred to as ocular mastocytosis, symptoms can include red, itchy, watery eyes and blurry vision.

Systemic mastocytosis (SM) is a rare hematological disease characterized by mast cells that are overactive and accumulate in different parts of the body such as the bone marrow, liver, spleen, gastrointestinal tract and lymph nodes.

Different subtypes of SM

When we speak about SM, we usually refer to the most common subtype of SM, indolent systemic mastocytosis (ISM). This is the mildest version of SM, with a manageable symptom burden and less effect on life expectancy. But there are several other subtypes possible as the disease progresses.

Read more about SM signs and symptoms

Smoldering systemic mastocytosis (SSM) has a greater effect on internal organs and less positive outlook than ISM. Aggressive systemic mastocytosis (ASM) is a more severe version of SM, with greater complications and lower survival rates, as well as possible ocular symptoms.

If the disease continues to progress to the most serious subtypes — systemic mastocytosis with an associated hematological neoplasm and mast cell leukemia — the disease burden increases; symptoms become harder to manage, and life expectancy is dramatically reduced.

Histamine release as a result of mast cell activity can cause symptoms in the eyes, such as blurred vision or red, itchy, watery eyes. Eye-related symptoms are not common in SM, but the effect on your vision can be progressively debilitating if the eyes are involved.

In the eye, mast cells accumulate in the conjunctiva, the mucus membrane that forms a protective film over the eye.

Managing SM symptom triggers

Triggers for the onset of SM symptoms are varied and may include alcohol, certain foods and medications, emotional stress, physical exertion, sudden changes in temperature, pollen, strong perfumes, skin friction and insect stings.

Triggers that activate mast cells in the eyes are usually pollen, animal dander and mold spores. Avoiding such triggers will avoid ocular symptoms and the eventual deterioration or loss of vision.

Treating eye SM symptoms

Your doctor will advise you on the appropriate medication for SM-related eye symptoms.

The most common treatment is a mast cell stabilizer known as cromolyn eye drops, which prevent mast cells from releasing histamine and other chemicals that cause the allergic reaction.

Antihistamine eye drops are also effective in managing ocular symptoms. Topical or oral steroids may also be prescribed.

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