Rheumatoid Arthritis In The Eyes

Not Often Discussed, But A Real Problem For Many RA Sufferers

A question for you – did you know you can actually lose your sight from rheumatoid arthritis in the eyes?

If left untreated and unchecked, it is very possible that rheumatoid arthritis will affect your eyes. Below is what you need to know….

Rheumatoid Arthritis In The Eyes – How Likely Is It?

Rheumatoid arthritis may be considered a disease primarily of the joints, but the fact is it can affect every part of your body and, if not controlled correctly, can permanently destroy many of your most delicate organs.

It is an auto-immune disease where your immune system turns on itself causing inflammation as it attacks your joints and sometimes other tissues.

This is also true for your eyes. Rheumatoid arthritis is the eyes can cause a host of dangerous conditions, that left untreated can ultimately cause you to lose your sight.

As cited in The Optometry Times, 25% of people with rheumatoid arthritis will develop eye problems as a result of the disease. Unfortunately, RA iswhen RA targets collagen in the body, this could be any collagen – including that part that makes up the cornea (the lens cap of your eye) or the sclera (the white outside).

The typical eye problems can be broken down in to 5 main conditions.

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Types Of Eye Damage With Rheumatoid Arthritis

1) Dryness or Dry Eye Syndrome (Technical name – ‘Keratitis Sicca’)

This is by far the most common ophthalmic problem for rheumatoid arthritis sufferers. The tear glands get damaged and stop producing the all-important film of tears that is vital for washing, cleaning and lubricating your eyes.

The corneal lens with start to dry out and ceases to be an effective barrier against dust or infection.

The first sign you are likely to notice of dry eye syndrome is a feeling of grit in your eye’. This is most likely to feel worse after concentrating on something (such as a book or TV screen) or just after waking up.

The result if you have dry eye syndrome is a very high likelihood of infection and eyes like a ‘dirty windscreen’ covered in dust. This in turn is highly likely to lead to scratches and scarring of the corneal lens.

Dry eye syndrome is often confused with Sjögren’s syndrome. They are the same in that they are both auto-immune diseases where your body turns on itself. Indeed, some people with rheumatoid arthritis get Sjögren’s syndrome as a result.

However, there are differences in the overall outcomes – for example according to the Sjögren’s Syndrome Foundation you are 40 times more likely to develop lymphoma with SS.

To confuse matters further you can also have primary rheumatoid arthritis and secondary Sjögren’s syndrome. The real take away message here is that f you first present with dry eyes, you get tested for both.

Treatment then depends on the anticipated cause.

If your dry eyes are likely to have been caused by a medication for your rheumatoid arthritis, then you should go back to your doctor and try something else immediately.

If not, then there are a range of eye drops/ salve that effectively act as artificial tears. There are also immunosuppressive eye drops that can be tried – all of which are designed to keep your eyes lubricated and clean in place of your tears.

Other factors that may help include wearing using dehumidifiers in rooms, wearing sunglasses and generally avoiding air conditioned rooms. 

 

2) Scleritis

The white part of your eye ball (the sclera) becomes inflamed. Basically rheumatoid arthritis in the eye can cause the sclera (or in some cases the cornea as well) to become really thin.

You’ll most notice likely first notice severe pain and redness that doesn’t go away with over-the-counter eye drops.

This can be so severe that any contact with the eye such as even a minor bump, could literally cause that part of your eyeball to split open.

Unfortunately, the rheumatoid arthritis attack is so deep within the eye, that normal surface treatments (eye drops) often can’t affect it.

Corticosteroid eye drops are likely to be the first attempt to get the inflammation under control, but when this doesn’t work, there is little that can be done other than going back to your overall treatment plan and trying to get a better hold of the inflammation.

Scleritis is considered an indication that your inflammation has got out of control and is literally all over your body at that point, so strong, effective inflammatory control all over is essential.

There is a weaker version of scleritis called ‘Episcleritis’. This is an attack purely on the tissue in front of the sclera (known as the episcleral). It is slightly more common than scleritis but the pain is less an it can be treated with eye drops or weak steroid drops in more severe cases.

3) Glaucoma

Glaucoma is the technical name for a collection of eye conditions resultant from damage to the optic nerve.

The eye is a delicately balanced object with a pump that keeps it inflated and delivers the right nutrients to the various parts. This pump then gets rid of the excess fluid (once it has been drained of goodness) through a pressure valve.

In the case of rheumatoid arthritis, inflammation attacks the release pump stopping it from working effectively. The result is a build up of fluid pressure inside the eye that damages your optic nerve and ends up with blurry or complete vision loss.

You’ll first notice the symptoms through either intense eye pain or blurred vision, particularly if the blurring also features blank spots or halos around bright lights at other times.

Treatment of glaucoma can range from eye drops to reduce pressure in your eye through to surgery to increase the flow of fluid again (also to reduce the pressure in your eye).

In some cases, use of corticosteroid therapy that actually lead to glaucoma. In such suspected cases, the answer is to go back to your doctor, get it confirmed and try a different option.

4) Cataracts

General inflammation in your eyeball will cause the lens in your eye to become cloudy. When the lens becomes cloudy, you are said to have cataracts.

Cataracts are characterised by blurry or poor vision, which is particularly bad at night. You may also experience difficulty seeing colours.

Once a lens has become cloudy, the most common treatment is for cataract surgery – the cloudy lens is removed (carefully cut out) from your eye and a new artificial lens is slid back in its place.

5) Iritis

This is when the coloured part of your eye becomes inflamed. Likely symptoms are blurred vision or seeing floating shapes in the corner of your vision.

Treatments For Rheumatoid Arthritis In The Eyes

If rheumatoid arthritis is diagnosed, then the treatment is likely to be two-fold – one treatment for the underlying inflammation (the RA) and one for the eye problem.

The type and course of treatment for the underlying rheumatoid arthritis will depend on how far advanced it is, what other remedies have been tried and what other parts of the body are affected. Typically, it might include prescription drugs such as NSAIDs or DMARDs.

By far the most likely treatment you’ll be given by your doctor for the damage to your eyes is some form of eye drop. The exact contents will depend on what symptoms and the likely problem you have.

It is important to remember that medications for rheumatoid arthritis in the eyes may also have a other direct impacts on your eyesight. So while you may be given a corticosteroid such as Prednisone for dry eyes, it is important to monitor your progress with an optometrist because a side effect of it’s use is the potential development of cataracts or glaucoma.

Similarly, Plaquenil (hydroxychloroquine) is also known to have triggered retinopathy (inflammation of the retina). The only answer again is to regularly visit your doctor or your optometrist for review so that any early signs of side effects can be prevented.

The Final Word –

Hopefully, we have now dispelled any thoughts you might have had about whether you can actually get an auto-immune disease. Rheumatoid arthritis in the eyes is a very real phenomenon that can lead to permanent blindness if not diagnosed correctly.

So who does diagnose ‘rheumatoid arthritis in the eyes’? That is not such an obvious question and some debate still rages about whether a rheumatologist or an ophthalmologist is best placed to assess and diagnose it.

Our view comes down with the ophthalmologist – but this doesn’t mean you shouldn’t also discuss it with all any other doctors you see as well.

Ultimately the most important thing is to see someone as soon as you get symptoms. If you already have diagnosed rheumatoid arthritis, then don’t even wait for symptoms – it can be present for months before showing obvious symptoms.

And we cant emphasize enough on helprelievepain.com – time is SINGLE most important factor in treating rheumatoid arthritis wherever it presents. 

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References Used –

1.https://www.optometrytimes.com/article/diagnosing-treating-ocular-manifestations-rheumatoid-arthritis (August 2013). Diagnosing, treating ocular manifestations of rheumatoid arthritis. The Optometry Times.

2. Dr Richard Brasington MD, Rheumatoid Arthritis and Sjögren’s Syndrome. Sjögren’s Syndrome Foundation

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