Arthritis & Eye Conditions
While most people think of arthritis as inflammation of the joints, increasingly, research is showing that inflammation can cause damage in unexpected ways and in unexpected places. Unfortunately, the eyes are not immune.
“The eye is like a microcosm of the entire body within a small little ball,” says Sunir J. Garg, MD, attending retina surgeon at Wills Eye Hospital in Philadelphia. Any inflammatory condition that affects collagen – the main component of connective tissue – such as rheumatoid arthritis (RA), can affect the sclera (the white of the eye) and the cornea (the lens cap), “which are basically entirely collagen,” says Dr. Garg.
Here are six eye conditions with connections to different forms of arthritis, and what you can do to protect your vision.
Keratitis Sicca (also called Dry Eye Syndrome)
What it is: The eye, for several reasons (including the consumption of certain medications or damage to tear-producing glands), is unable to maintain a healthy film of tears. This film not only lubricates the eye, it also protects they eye from foreign particles and is necessary for good vision.
What you may notice: Dryness and perhaps the feeling of having something in your eye; vision may also be blurred. “When the corneal lens start to dry out, it’s not an effective barrier,” says Dr. Garg. As a result, this condition may lead to infection and corneal scarring – which, Dr. Garg says, is like having “a dirty windshield.”
Who it affects: Those with Sjögren’s syndrome, RA, scleroderma. “Dry eye syndrome is the most common ophthalmic manifestation of rheumatoid arthritis,” says Careen Lowder, MD, PhD, an ophthalmologist at Cleveland Clinic. “Women are nine times more commonly affected than men.”
What you can do: For eyes made dry by Sjögren’s syndrome, controlling the underlying inflammation with the medications you take for your arthritis could provide some relief, but you’ll probably also need a topical salve, artificial tears or an immunosuppressive eye drop such as cyclosporine (Restasis) to keep your eyes moist. Tear duct plugs (called punctal plugs) are another option. Running a humidifier in your bedroom at night may also help.
Dryness caused by medications may be relieved by switching to another medication or lowering the dose. (But never make any medication changes without consulting your doctor.) Artificial tears also can offset dryness caused by medications.
What it is: Inflammation of the sclera, or white part of the eye. “[Inflammatory arthritis] conditions like RA can cause the eye wall, which is the sclera, or the cornea, to become thin,” says Dr. Garg. “That’s bad because minor trauma could cause that part of the eyeball to split open,” he says.
What you may notice: Redness that doesn’t go away with the use of over-the-counter eye drops (like Visine), severe pain (described as “deep, boring eye pain” by Dr. Lowder), sensitivity to light and perhaps reduced vision
Who it affects: Those with RA, relapsing polychondritis and granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis)
What you can do: In some cases, corticosteroid eye drops can control inflammation, but often the problem is too deep within the eye to be controlled locally. Scleritis is usually an indication that inflammation is out of control, not only in the eye but elsewhere in the body, so keeping your arthritis under control is critical.
What it is: Inflammation of the uvea, the vascular layer of the eye, which is sandwiched between the retina and the sclera.
What you may notice: Pain, redness, blurred vision and sensitivity to light. If not controlled, uveitis can lead to vision loss.
Who it affects: Those with Juvenile arthritis, ankylosing spondylitis, psoriatic arthritis, reactive arthritis and Behçet’s disease.
What you can do: Keeping your disease under control can help to minimize your risk, but if you notice symptoms of uveitis, contact your doctor right away. A corticosteroid eye drop is usually the first-line treatment. If it doesn’t help enough, your doctor may prescribe an oral corticosteroid or inject the eye with a corticosteroid. If an infection is the cause, antibiotics may be needed.
Retinal Vascular Occlusion
What it is: Small blood vessels that feed the retina, or light sensing layer of the eye, become blocked or backed up, akin to what happens during a heart attack or stroke.
What you may notice: Vision loss, like a curtain coming over the eye. If an artery is blocked, loss of vision may happen suddenly and come and go. If a vein is backed up, vision loss may be more gradual.
Who it affects: Those with lupus, scleroderma, Behçet’s disease, sarcoidosis, polyarteritis nodosa and primary CNS angiitis
What you can do: If an artery has been blocked, damage may be permanent and there is currently no known treatment to restore vision. If a vein is backed up, laser surgery may help reduce swelling and restore vision.
What it is: A group of eye conditions that result in damage to the optic nerve, which can cause vision loss. High pressure inside the eye is usually, but not always, the cause. The eye has a pump that keeps the eye inflated and circulates nutrients, explains Dr. Garg. “Fluid that’s made by the pump has to be released from the eye through a pressure relief valve. If you get inflammation in the valve, the eye pressure can go up and cause glaucoma.”
What you may notice: Eye pain, vision that’s blurry or has blank spots, rainbow-colored halos around lights. In its early stages, glaucoma has no symptoms.
Who it affects: Those with ankylosing spondylitis, psoriatic arthritis and other types of inflammatory arthritis. Glaucoma also can be a side effect of corticosteroid therapy for arthritis.
What you can do: Regular eye exams can identify the problem early and improve prognosis. Treatment for glaucoma involves one or a combination of different eye drops to reduce pressure in eye. If those aren’t successful, surgery can be used to increase the flow of aqueous fluid from the eye and lower pressure.
The best way to prevent glaucoma related to corticosteroid therapy is to work with your doctors to minimize corticosteroid use, taking the lowest doses for the shortest time possible to produce desired results.
What it is: “If you have inflammation in the eyeball, that inflammation will cause the lens, which should be crystal clear, to start to become cloudy. And that’s a cataract,” says Dr. Garg.
What you may notice: Cloudy or blurry vision, poor night vision, colors that seem faded
Who it affects: Those with “[inflammatory] conditions that affect the inside of the eye,” says Dr. Garg. In particular, genetic variations common in people with RA, ankylosing spondylitis and psoriatic arthritis increase the risk of eyeball inflammation. Taking oral or topical steroids also increases the risk.
What you can do: Cataracts can be treated with surgery, in which the cloudy lens is removed and replaced with an artificial lens.